Publications by authors named "Lorenzo Nigro"

26 Publications

  • Page 1 of 1

Investigating Plant Micro-Remains Embedded in Dental Calculus of the Phoenician Inhabitants of Motya (Sicily, Italy).

Plants (Basel) 2020 Oct 20;9(10). Epub 2020 Oct 20.

Department of Biology, University of Rome "Tor Vergata", Via della Ricerca Scientifica 1, 00133 Rome, Italy.

Plant records reveal remarkable evidence about past environments and human cultures. Exploiting dental calculus analysis and using a combined approach of microscopy and gas chromatography mass spectrometry, our research outlines dietary ecology and phytomedicinal practices of the ancient community of Motya (Sicily, eight to sixth century BC), one of the most important Phoenician settlements in the Mediterranean basin. Micro-remains suggest use or consumption of Triticeae cereals, and animal-derived sources (e.g., milk and aquatic birds). Markers of grape (or wine), herbs, and rhizomes, endemic of Mediterranean latitudes and the East, provide insight into the subsistence of this colony, in terms of foodstuffs and phytotherapeutic products. The application of resins and wood of Gymnosperms for social and cultural purposes is hypothesized through the identification of Pinaceae secondary metabolites and pollen grains. The information hidden in dental calculus discloses the strong human-plant interaction in Motya's Phoenician community, in terms of cultural traditions and land use.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/plants9101395DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590007PMC
October 2020

A Case of Spinal Cord Compression Due to Paraspinal Musculature After Cervical Laminectomy.

World Neurosurg 2019 Dec 23;132:12-13. Epub 2019 Aug 23.

Department of Human Neurosciences, "Sapienza" University of Rome, Italy.

Background: Only a few cases of spinal cord compression after cervical laminectomy have been reported.

Case Description: We report a case of tetraparesis after executing a C3-C6 anterior and posterior decompression and fusion. Cervical magnetic resonance imaging demonstrated a spinal cord compression due to the impingement of the paraspinal muscles through the laminectomy. The patient experienced a spontaneous neurological recovery and the follow-up cervical magnetic resonance imaging showed resolution of the spinal cord compression.

Conclusions: This rare complication should be considered among the others after executing a cervical laminectomy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.wneu.2019.08.098DOI Listing
December 2019

Ancient DNA of Phoenician remains indicates discontinuity in the settlement history of Ibiza.

Sci Rep 2018 12 4;8(1):17567. Epub 2018 Dec 4.

Department of Anatomy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.

Ibiza was permanently settled around the 7 century BCE by founders arriving from west Phoenicia. The founding population grew significantly and reached its height during the 4 century BCE. We obtained nine complete mitochondrial genomes from skeletal remains from two Punic necropoli in Ibiza and a Bronze Age site from Formentara. We also obtained low coverage (0.47X average depth) of the genome of one individual, directly dated to 361-178 cal BCE, from the Cas Molí site on Ibiza. We analysed and compared ancient DNA results with 18 new mitochondrial genomes from modern Ibizans to determine the ancestry of the founders of Ibiza. The mitochondrial results indicate a predominantly recent European maternal ancestry for the current Ibizan population while the whole genome data suggest a significant Eastern Mediterranean component. Our mitochondrial results suggest a genetic discontinuity between the early Phoenician settlers and the island's modern inhabitants. Our data, while limited, suggest that the Eastern or North African influence in the Punic population of Ibiza was primarily male dominated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-018-35667-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279797PMC
December 2018

Delayed surgery in neurologically intact patients affected by thoraco-lumbar junction burst fractures: to reduce pain and improve quality of life.

J Spine Surg 2018 Jun;4(2):397-402

Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.

Background: This is a retrospective study on 18 patients affected by thoraco-lumbar junction burst fractures (TLJBF) A3 or A4 at computed tomography (CT) scan who referred to our hospital. To assess the surgical results in terms of pain and quality of life in a series of neurologically intact patients affected by TLJBF who underwent surgery after 3-4 months from the injury. In literature there is controversy if pain could be an indication for surgery in TLJBF and series of patients conservatively managed with success have been reported.

Methods: A retrospective study on 18 patients is reported. Patients included in this series were neurologically intact and affected by a TLJBF A3 or A4 at CT scan, the height of the burst vertebral body was >50%, spinal canal invasion was <30% and kyphosis deformity <30 degrees. Pain and quality of life were evaluated using graphic rating scale (GRS) and EuroQol (EQ-5D) scores on admission, at the clinical follow-up and in post-surgical period.

Results: Comparing pre- and post-operative EQ-5D, the scores had a statistically significant decrease after the operation (P<0.001) [pre-surgery EQ-5D was 2.60 (SD =0.67), post-surgery EQ-5D was 1.37 (SD =0.41)]. Also analyzing the EQ5D-VAS scores, the t-test revealed that surgery (P<0.01) improved the quality of life with statistically significance (EQ5D-VAS pre =43.89, SD =12.43 and EQ5D-VAS post =73.33, SD =10.84). Analyzing pre- and post-surgical GRS scores, the pain decreased significantly with the maximum mean difference among the 2nd and 3rd month before surgery and at 12 months after surgery (respectively D =5.444, P<0.001 and D =5.167, P<0.001).

Conclusions: Conservatively managed patients affected by TLJBF require a strict clinical follow-up since pain sometimes is present in the following months and it affects the quality of life. Surgery should be considered for these cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2018.05.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6046318PMC
June 2018

Considerations regarding supplementary motor area syndrome after surgery for parasagittal meningiomas.

Acta Neurochir (Wien) 2018 08 22;160(8):1555-1556. Epub 2018 Jun 22.

Department of Neurology and Psychiatry, "Sapienza" University of Rome, viale dell'Università 121, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-018-3604-yDOI Listing
August 2018

Total en-bloc spondylectomy through a posterior approach: technique and surgical outcome in thoracic metastases.

Acta Neurochir (Wien) 2018 07 28;160(7):1373-1376. Epub 2018 May 28.

Department of Neurology and Psychiatry, University of Rome, Rome, Italy.

Background: In 1981, Roy-Camille et al. have firstly reported the total en-bloc spondylectomy (TES) through a posterior approach for cases of malignant spine tumors in order to reduce the local recurrence and to increase the patient's survival. By then, this surgery has been increasingly gaining recognition. However, it requires a high level of technical ability and knowledge of spinal anatomy, physiology, and biomechanics.

Method: Herein, we report the patient's selection and technique to execute the TES for cases of thoracic metastasis.

Conclusion: This surgery is technically demanding so the patient's selection requires a careful pre-operative evaluation. However, it can be suggested for patients affected by intracompartmental lesions with a good prognosis since the tumor's progression is "limited" by local barriers as demonstrated by histological studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-018-3572-2DOI Listing
July 2018

Spinal epidural lipomatosis: a rare condition with unclear etiology.

J Neurosurg Sci 2019 06 9;63(3):352-354. Epub 2018 May 9.

Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.23736/S0390-5616.17.04129-7DOI Listing
June 2019

Revision surgery for degenerative spinal deformity: a case report and review of the literature.

Spinal Cord Ser Cases 2017 30;3:17085. Epub 2017 Nov 30.

1Department of Neurosurgery, Sapienza University, Viale del Policlinico 115, 00161, Rome, Italy.

Introduction: Management of spinal degenerative deformities always represents a challenge for the spinal surgeon.

Case Presentation: We report a case of revision surgery for adult scoliosis, focusing of most common errors in pre-surgical management and criteria for reoperation. We analyzed the spino-pelvic parameters on the standing whole-spine X-ray and the role of sagittal balance. To restore 45° of lumbar lordosis, we performed a L3 Pedicle Subtraction Osteotomy (PSO), along with L2-L3 and L3-L4 eXtreme Lateral Interbody Fusion (XLIF).

Discussion: In cases of adult scoliosis, careful preoperative planning is necessary in an attempt to avoid difficult, expensive, and high-risk additional procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41394-017-0008-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798913PMC
November 2017

Vertebral hemangiomas: common lesions with still many unknown aspects.

J Spine Surg 2017 Jun;3(2):309-311

Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2017.05.11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506294PMC
June 2017

A case of cervical tuberculosis with severe kyphosis treated with a winged expandable cage after double corpectomy.

J Spine Surg 2017 Jun;3(2):304-308

Division of Neurosurgery, Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.

In this case report, we demonstrate that the use of a winged expandable cage was able to obtain good clinical and radiological results in a case of cervical tuberculosis with severe kyphosis. However, case series will be necessary to affirm its validity as a stand-alone device for similar cases with high risk of instability.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2017.06.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506313PMC
June 2017

C5 palsy after insertion of a winged expandable cervical cage: a case report and literature review.

J Spine Surg 2017 Jun;3(2):300-303

Department of Neurology and Psychiatry, "Sapienza" University of Rome, Rome, Italy.

C5 nerve root palsy is a well-known complication after anterior or posterior cervical decompression. Many theories have been proposed but the etiology is still unclear. The use of a winged expandable cage after single or multiple corpectomy is among the used techniques in reconstructing the cervical spine. Herein we report a case of C5 palsy after a three-level corpectomy and reconstruction using this device for the treatment of cervical spondylosis. In our case the preexisting foraminal stenosis, wide anterior decompression and partial improvement of cervical alignment were factors supposed contributing to the palsy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2017.06.03DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506319PMC
June 2017

Static and dynamic cervical MRI: two useful exams in cervical myelopathy.

J Spine Surg 2017 Jun;3(2):212-216

1Department of Neurology and Psychiatry, 2Department of Psychology, "Sapienza" University of Rome, Rome, Italy.

Background: Cervical magnetic resonance imaging (MRI) is the gold standard exam in the assessment of patients affected by cervical myelopathy and is very useful in planning the operation. Herein we present a series of patients affected by long tract symptoms who underwent dynamic MRI in addition to the static exam.

Methods: In the period between March 2010 and March 2012, three-hundred-ten patients referred to our department since affected by neck/arm pain or symptoms related to cervical myelopathy. Thirty-eight patients complained "long-tract symptoms" related to cervical myelopathy. This series of patients was enrolled in the study. All patients underwent clinical and neurological exam. In all the cases, a static and dynamic cervical MRI was executed using a 3.0-T superconducting MR unit (Intera, Philips, Eindhoven, Netherlands). The dynamic exam was performed with as much neck flexion and extension the patient could achieve alone. On T2-weigthed MRI each level was assessed independently by two neuroradiologists and Muhle scale was applied.

Results: According to Muhle's classification of spinal cord compressions, static MRI demonstrated 156 findings: 96 (61.54%) anterior and 60 (38.46%) posterior. Dynamic MRI showed 186 spinal cord compressions: 81 (43.5%) anterior and 105 (56.5%) posterior. The anterior compressions were: grade 1 in 23 cases (28.4%), grade 2 in 52 cases (64.2%), grade 3 in 6 cases (7.4%). The posterior compressions were: 32 (30.48%) of grade 1, 60 (57.14%) of grade 2, 13 (12.38%) of grade 3.

Conclusions: The dynamic MRI demonstrated a major number of findings and spinal cord compressions compared to the static exam. Finally, we consider the dynamic exam able to provide useful information in these patients, but we suggest a careful evaluation of the findings in the extension exam since they are probably over-expressed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/jss.2017.06.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506301PMC
June 2017

Lumbar Annular Tear in the Absence of Nerve Root Compression: Is Discectomy Useful?

J Neurosci Rural Pract 2016 Dec;7(Suppl 1):S126-S128

Department of Neurology and Psychiatry, Neurosurgical Division, University of Rome "Sapienza" Policlinico Umberto I, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0976-3147.196449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244047PMC
December 2016

Lumbar Annular Tear in the Absence of Nerve Root Compression: Is Discectomy Useful?

J Neurosci Rural Pract 2016 Dec;7(Suppl 1):S126-S128

Department of Neurology and Psychiatry, Neurosurgical Division, University of Rome "Sapienza" Policlinico Umberto I, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0976-3147.196449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244047PMC
December 2016

Letter to the Editor: Aggressive vertebral hemangiomas.

Authors:
Lorenzo Nigro

Neurosurg Focus 2016 Nov;41(5):E12

"Sapienza" University of Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3171/2016.8.FOCUS16334DOI Listing
November 2016

A recent experience as neurosurgical registrar in UK. "Legal" differences with the Italian system and on-call duties.

Authors:
Lorenzo Nigro

Acta Neurochir (Wien) 2016 Dec 19;158(12):2253-2257. Epub 2016 Oct 19.

Division of Neurosurgery, Department of Neurology and Psychiatry "Sapienza", University of Rome, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-016-2987-xDOI Listing
December 2016

Decompression versus decompression and fusion for degenerative lumbar stenosis: analysis of the factors influencing the outcome of back pain and disability.

J Spine Surg 2016 Mar;2(1):52-8

Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Italy ;

Background: The objective of this study is to evaluate the factors influencing the outcome of back pain and disability in patients operated for lumbar stenosis without instability and deformity using two classical surgical techniques: decompression alone and decompression plus fusion.

Methods: This is a retrospective cohort study of patients who underwent lumbar surgery with standard posterior decompression or standard posterior decompression plus pedicle screw fixation for degenerative lumbar stenosis without deformity, spondylolisthesis or instability at our department from June 2010 to January 2014. They were divided into two groups: decompression group (D) and decompression-fusion group (F). We analyzed the following factors: age, gender, levels of stenosis, pre-surgical "micro-instability", and post-surgical "micro-instability".

Results: A total of 174 patients were enrolled in the study. Both Graphic Rating Scale (GRS) and Oswestry Disability Index (ODI) scores were significantly decreased after surgery (P<0.001). Female patients appeared to have lesser improvements from surgery, for both D and F groups. An analysis of variance using the decrease of pain (GRS pre-post) as dependent variable and type of surgery, age, gender and their interaction as factors showed that the main effects of type of surgery and gender were significant. The analysis of variance for the decrease of pain (GRS) and disability (ODI) according to the levels of stenosis showed a significant interaction for GRS scores. Female patients that underwent fixation surgery reported the least improvement in disability. A significant interaction was found on the one-way analysis of variance for the D group without pre-surgical micro-instability using post-surgical micro-instability as factor.

Conclusions: Our study supports posterior decompression alone as the gold standard option as treatment for lumbar stenosis without instability and deformity. Additional fusion should be considered only to prevent post-surgical instability. The "micro-instability" is a radiological finding that has its clinical surrogate but is not able to guide the choice of the type of surgery. Moreover the significance of "micro-instability" is still unclear. We suggest a prospective study following patients with asymptomatic micro-instability to definitively understand the clinical history.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5039834PMC
http://dx.doi.org/10.21037/jss.2016.03.07DOI Listing
March 2016

Letter to the editor: Microsurgical decompression for central lumbar spinal stenosis: a single-center observational study.

Acta Neurochir (Wien) 2016 11 20;158(11):2231. Epub 2016 Sep 20.

Department of Neurology and Psychiatry "Sapienza" University of Rome, viale del Policlinico, Rome, Italy.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00701-016-2961-7DOI Listing
November 2016

Cervical reconstruction techniques. After adequate selection of the patient report of a series of 34 patients treated with winged expandable cages.

Neurosurg Rev 2017 Apr 2;40(2):281-286. Epub 2016 Aug 2.

Department of Neurology and Psychiatry, Division of Neurosurgery, "Sapienza" University of Rome, Rome, Italy.

After single or multilevel cervical corpectomy for the treatment of different diseases, many surgical options have been proposed over the years. As a single device, a winged expandable titanium cage (WETC) has been developed. We report the use of this device and our clinical results at 24 months of follow-up in a prospective series of 34 patients who underwent single or multilevel corpectomy for the treatment of cervical spondylosis. Thirty-four consecutive patients underwent single or multilevel cervical corpectomy followed by the insertion of a WETC for the treatment of cervical spondylosis at Department of Neurology and Psychiatry "Sapienza" University of Rome, Italy, from May 2011 to May 2013. Patients affected by cervical spondylosis with cervical lordosis >0° were included. Patients affected by cervical lordosis <0°, osteoporosis, or other cervical diseases were excluded. The mean postsurgical Nurick's grade was significantly lower than the mean presurgical Nurick's grade (mean = 0.98 for postsurgical Nurick's grade and mean = 2.42 for presurgical Nurick's grade). Four patients (11.7 %) presented subsidence respectively of 1, 2, 2, and 3 mm at 24 months of radiological follow-up. Postoperative complications occurred in five patients (14.7 %). Our case series at 24 months of follow-up demonstrates that the use of a WETC obtains good clinical results after single or multiple corpectomy in patients not affected by osteoporosis who do not require cervical lordosis correction. During the insertion of the device, an adequate preparation of the end plates is suggested and their over distraction should be avoided.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10143-016-0770-3DOI Listing
April 2017

Surgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal.

Neurosurg Rev 2015 Jul 27;38(3):585-92; discussion 592. Epub 2015 Feb 27.

Department of Neurology and Psychiatry, Division of Neurosurgery, University of Rome "Sapienza", Viale del Policlinico 155, 00161, Rome, Italy.

Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. The purpose of this study is to propose a novel algorithm of treatment about VHs. This is a case report of an extensive VH and a review of the literature. A case of vertebral fracture during radiotherapy at a total dose of 30 Gy given in 10 fractions (treatment time 2 weeks) using a linear accelerator at 15 MV high-energy photons for extensive VH is reported. Using PubMed database, a review of the literature is done. The authors have no study funding sources. The authors have no conflicting financial interests. In the literature, good results in terms of pain and neurological deficits are reported. No cases of vertebral fractures are described. However, there is no consensus regarding the treatment for VHs. Radiotherapy is widely utilized in VHs determining pain. Surgery for VHs determining neurological deficit is also widely accepted. Perhaps, regarding the width of the lesion, no indications are given. We consider it important to make an evaluation before initiating the treatment for the risk of pathologic vertebral fracture, since in radiotherapy, there is no convention regarding structural changes determined in VHs. We propose a new algorithm of treatment. We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10143-015-0616-4DOI Listing
July 2015

Surgery of intradural extramedullary tumors: retrospective analysis of 107 cases.

Neurosurgery 2014 Nov;75(5):509-14; discussion 514

*Department of Neurology and Psychiatry, Division of Neurosurgery, and ‡Department of Psychology of Developmental and Socialization Processes, Sapienza University of Rome, Rome, Italy.

Background: Intradural extramedullary tumors (IDEMTs) are uncommon lesions that cause pain and neurological deficits.

Objective: To evaluate the effects of surgery for IDEMTs.

Methods: This cohort study recruited all patients operated on for IDEMTs at the Department of Neurology and Psychiatry of Sapienza University of Rome from January 2003 to January 2013. The analysis was conducted on clinical records evaluation over a 1-year follow-up. The Graphic Rating Scale was used to assess pain. Neurological deficits were detected through neurological examination. Quality of life was evaluated with the EuroQol (EQ-5D). Statistical interpretation of the data was performed with SPSS version 19 software.

Results: One hundred seven patients were recruited. Three were lost to follow-up. Patients reported lower level of pain 1 year after surgery (before surgery, 6.05; after surgery, 3.65). Mean comparison showed a significant decrease of -2.400 (P < .001). Ninety-two patients (88.5%) were neurologically asymptomatic 1 year after surgery. Only 12 patients (11.5%) presented with a deficit, with a global decrease of 39% (χ(2) = 27.6; P < .005). The quality of life in patients was middle to high (mean rating of EQ-5D visual analog score, 61.78%). The lowest levels of quality of life were found in patients with sphincter dysfunctions (mean, 33.4).

Conclusion: Surgery for IDEMTs has a good outcome. Patients reported lower levels of pain and a drastic reduction in neurological symptoms 1 year after surgery. The quality of life is middle to high. It is influenced mainly by the neurological outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1227/NEU.0000000000000513DOI Listing
November 2014

Syringomyelia associated with cervical spondylosis: A rare condition.

World J Clin Cases 2013 Jun;1(3):111-5

Alessandro Landi, Lorenzo Nigro, Nicola Marotta, Cristina Mancarella, Pasquale Donnarumma, Roberto Delfini, Division of Neurosurgery, Department of Neurology and Psichiatry, University of Rome Sapienza, 00181 Rome, Italy.

Spinal spondylosis is an extremely common condition that has only rarely been described as a cause of syringomyelia. We describe a case of syringomyelia associated with cervical spondylosis admitted at our division and treated by our institute. It is the case of a 66-year-old woman. At our observation she was affected by moderate-severe spastic tetraparesis. T2-weighted magnetic resonance imaging (MRI) showed an hyperintense signal within spinal cord from C3 to T1 with a more sharply defined process in the inferior cervical spinal cord. At the same level bulging discs, facets and ligamenta flava hypertrophy determined a compression towards subarachnoid space and spinal cord. Spinal cord compression was more evident in hyperextension rather than flexion. A 4-level laminectomy and subsequent posterior stabilization with intra-articular screws was executed. At 3-mo follow up there was a regression of tetraparesis but motor deficits of the lower limbs residuated. At the same follow up postoperative MRI was executed. It suggested enlargement of the syrinx. Perhaps hyperintensity within spinal cord appeared "bounded" from C3 to C7 with clearer margins. At the level of surgical decompression, subarachnoid space and spinal cord enlargement were also evident. A review of the literature was executed using PubMed database. The objective of the research was to find an etiopathological theory able to relate syringomyelia with cervical spondylosis. Only 6 articles have been found. At the origin of syringomyelia the mechanisms of compression and instability are proposed. Perhaps other studies assert the importance of subarachnoid space regard cerebrospinal fluid (CSF) dynamic. We postulate that cervical spine instability may be the cause of multiple microtrauma towards spinal cord and consequently may damage spinal cord parenchyma generating myelomalacia and consequently syrinx. Otherwise the hemorrhage within spinal cord central canal can cause an obstruction of CSF outflow, finally generating the syrinx. On the other hand in cervical spondylosis the stenotic elements can affect subarachnoid space. These elements rubbing towards spinal cord during movements of the neck can generate arachnoiditis, subarachnoid hemorrhages and arachnoid adhesions. Analyzing the literature these "complications" of cervical spondylosis are described at the origin of syringomyelia. So surgical decompression, enlarging medullary canal prevents rubbings and contacts between the bone-ligament structures of the spine towards spinal cord and subarachnoid space therefore syringomyelia. Perhaps stabilization is also necessary to prevent instability of the cervical spine at the base of central cord syndrome or syringomyelia. Finally although patients affected by central cord syndrome are usually managed conservatively we advocate, also for them, surgical treatment in cases affected by advanced state of the symptoms and MRI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12998/wjcc.v1.i3.111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3845911PMC
June 2013
-->