Tabes Dorsalis in a Patient Presenting With Right Lower Extremity Paresthesia and Cervical Spine Pain

OBJECTIVEVascular malformations of the cervical spine are exceedingly rare. To date there have been no large case series describing the clinical presentation and angioarchitectural characteristics of cervical spine vascular malformations. The authors report their institutional case series on cervical spine vascular malformations diagnosed and treated at their institution.METHODSThe authors retrospectively reviewed all patients with spinal vascular malformations from their institution from January 2001 to December 2018. Patients with vascular malformations of the cervical spine were included. Lesions were characterized by their angioarchitectural characteristics by an interventional neuroradiologist and endovascular neurosurgeon. Data were collected on clinical presentation, imaging findings, treatment outcomes, and long-term follow-up. Descriptive statistics are reported.RESULTSOf a total of 213 patients with spinal vascular malformations, 27 (12.7%) had vascular malformations in the cervical spine. The mean patient age was 46.1 ± 21.9 years and 16 (59.3%) were male. The most common presentations were lower-extremity weakness (13 patients, 48.1%), tetraparesis (8 patients, 29.6%), and lower-extremity sensory dysfunction (7 patients, 25.9%). Nine patients (33.3%) presented with hemorrhage. Fifteen patients (55.6%) had modified Rankin Scale scores of 0–2 at the time of diagnosis. Regarding angioarchitectural characteristics, 8 patients (29.6%) had intramedullary arteriovenous malformations (AVMs), 5 (18.5%) had epidural arteriovenous fistulas (AVFs), 4 (14.8%) had paraspinal fistulas, 4 (14.8%) had mixed epidural/intradural fistulas, 3 (11.1%) had perimedullary AVMs, 2 (7.4%) had dural fistulas, and 1 patient (3.7%) had a perimedullary AVF.CONCLUSIONSThis retrospective study of 27 patients with cervical spine vascular malformations is the largest series to date on these lesions. The authors found substantial angioarchitectural heterogeneity with the most common types being intramedullary AVMs followed by epidural AVFs, paraspinal fistulas, and mixed intradural/extradural fistulas. Angioarchitecture dictated the clinical presentation as intradural shunts were more likely to present with hemorrhage and acute onset myelopathy, while dural and extradural shunts presented as either incidental lesions or gradually progressive congestive myelopathy.

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Charcot Arthropathy of the Wrist Associated with Cervical Spondylotic Myelopathy

Global Spine Journal ◽

10.1055/s-0032-1315457 ◽

2012 ◽

Vol 2 (4) ◽

pp. 227-230

Author(s):

Keith Jackson ◽

Uma Ramadorai ◽

Brian Abell ◽

John DeVine

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Spine ◽

Magnetic Resonance ◽

Upper Extremity ◽

Neurological Examination ◽

Appendicular Skeleton ◽

Charcot Arthropathy ◽

Resonance Imaging ◽

Tabes Dorsalis ◽

Radiocarpal Joint

Background Charcot arthropathy is a cascade of destructive changes that can effect joints of both the axial and appendicular skeleton. The pathogenesis of this condition centers around the accumulation of minor traumatic events after the loss of normal joint sensation. The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, and magnetic resonance imaging of the cervical spine should be obtained at presentation. Case Report A 72-year-old woman presented with a painless right wrist deformity. Radiographs demonstrated advanced destructive changes of the radiocarpal joint. Magnetic resonance imaging of the cervical spine revealed multilevel cervical spondylotic stenosis with cord deformation, but no evidence of syringomyelia. Neurological examination confirmed the presence of myelopathy. Literature Review The most frequently cited cause of Charcot arthropathy of the upper extremity is syringomyelia, although pathologies such as diabetes mellitus, tabes dorsalis, leprosy, and other disorders affecting the nervous system have been reported to lead to this condition. Neuropathic arthropathy involving the wrist is a rare phenomenon with fewer than 20 published reports in modern literature. Clinical Relevance Charcot arthropathy of the wrist is a rare but potentially disabling condition. The diagnosis of spondylotic myelopathy should be considered when evaluating a patient with this presentation. Evaluation consisting of a detailed neurological examination and advanced imaging of the cervical spine is warranted to identify the etiology.

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Muscle Dysfunction in Cervical Spine Pain: Implications for Assessment and Management

Journal of Orthopaedic and Sports Physical Therapy ◽

10.2519/jospt.2009.2872 ◽

2009 ◽

Vol 39 (5) ◽

pp. 324-333 ◽

Cited By ~ 116

Author(s):

Shaun O'Leary ◽

Deborah Falla ◽

James M. Elliott ◽

Gwendolen Jull

Keyword(s):

Cervical Spine ◽

Muscle Dysfunction ◽

Spine Pain

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The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain

BMC Musculoskeletal Disorders ◽

10.1186/1471-2474-10-157 ◽

2009 ◽

Vol 10 (1) ◽

Cited By ~ 9

Author(s):

Stefano Gumina ◽

Stefano Carbone ◽

Valerio Arceri ◽

Alessandro Rita ◽

Anna R Vestri ◽

...

Keyword(s):

Cervical Spine ◽

Acromioclavicular Joint ◽

Acromioclavicular Joint Dislocation ◽

Chronic Type ◽

Joint Dislocation ◽

Type Iii ◽

Spine Pain ◽

The Relationship

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Cervical Spine

10.1093/med/9780190626761.003.0007 ◽

2018 ◽

Author(s):

Siddarth Thakur ◽

Salahadin Abdi

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Single Source ◽

Management Options ◽

Therapeutic Challenge ◽

Treatment Regimens ◽

Spine Pain ◽

Complex Anatomy ◽

Multiple Structures

Pain emanating from the cervical spine represents a significant diagnostic and therapeutic challenge for clinicians. The precise etiology of the pain may be difficult to identify because there are many potential pain-generating structures in the cervical spine and surrounding region. It is helpful to delineate the patient’s symptoms as axial- or radicular-predominant in order to guide the investigation prior to initiating treatment. The evidence for many commonly used treatment regimens is variable, and therefore an individualized plan is often necessary. Although it is conceptually accommodating to compartmentalize the etiology of cervical spine pain from a single source, the reality is that multiple structures are often involved, given the complex anatomy of the cervical spine. This chapter discusses cervical spine anatomy and biomechanics, as well as the etiology, pathophysiology, and management options for axial and radicular neck pain.

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The effectiveness of therapeutic massage in lumbar and cervical spine pain syndrome – case study

HIGHER SCHOOL’S PULSE ◽

10.5604/01.3001.0003.4319 ◽

2015 ◽

Vol 9 (2) ◽

pp. 24-27

Author(s):

Iwona Wilk

Keyword(s):

Cervical Spine ◽

Lower Limb ◽

Pain Syndrome ◽

Lymphatic Drainage ◽

Lower Limbs ◽

Substantial Part ◽

Therapeutic Massage ◽

Spine Pain ◽

Patient Reported ◽

Pain Symptoms

Background: The spine pain syndrome is a common problem in a substantial part of the population which currently affects younger and younger people. The underlying risk factors include the character of work, sedentary lifestyle and lack of physical activity. Except for complex physiotherapy which should be applied during treatment, a lifestyle prophylaxis also seems to be a key factor. Aim of the study: The aim of this study was to present the possibility to use the classical and therapeutic massage of the back, and a lymphatic drainage of lower limbs in case of the lumbar and cervical spine pain syndrome accompaniedby the lower limb swelling. Material and methods: A young woman with the lumbar and cervical spine pain syndrome received a 55-minute lymphatic drainage (four sessions), a 30-minute classical massage (four sessions) and a 45-minute therapeutic massage (two sessions). All the procedures were performed every two days. Results: After the application of all kinds of the massage, selected individually to current symptoms and needs of the patient, the pain in the area of the spine was relieved. After the therapy the pressure pain in the back muscles such as: latissimus dorsi (lats), trapezius (traps) and spinal erectors was also decreased. The swelling in the area of the lower limb was reduced and the patient reported general decrease of pain. Conclusions: A massage may constitute an effective anti-pain therapy in case of the lumbar and cervical spine pain syndrome. Combined with educating patients about proper motor habits might prevent similar pain symptoms in the future.

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