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As alluded to earlier, multiple arachnoid cysts in the thoracic or lumbar region have been associated with ankylosing spondylitis and with Marfan syndrome Rheumatoid Arthritis The spinal changes of rheumatoid arthritis differ somewhat from those of ankylosing spondylitis although the latter too may be a cause of atlantoaxial dislocation (see further on under Anomalies at the Craniocervical Junction The ligaments that attach the odontoid to the atlas and to the skull and the joint tissue are weakened by the destructive in ammatory process The subsequent dislocation of the atlas on the axis may remain mobile or become xed and give rise to an intermittent or persistent mild to moderate paraparesis or quadriparesis Similar effects may result from a forward subluxation of C4 on C5 (see Nakano et al) Atlantoaxial dislocation is known to be a cause of collapse and sudden death If the upper cervical cord is compressed, the odontoid process must be removed and C1 C2 decompressed and stabilized Other levels of the spine are less frequently affected Ossi cation of the Posterior Longitudinal Ligament (OPLL) Compressive cervical myelopathy due to this unusual process occurs almost exclusively in patients of Japanese extraction and has been demonstrated to us as an almost mundane nding by colleagues in Hawaii The clinical signs are much the same as those of cervical spondylosis, but the radiologic appearance of cancellous bone along a segment of the posterior longitudinal ligament is unique The ligamentous calci cation can be seen on plain lms, CT scan, and MRI and may be mistaken for spondylotic change The ossi ed areas may enlarge enough to form islands of bone marrow Laminoplasty with enlargement of the spinal canal has been successful Cervical Dural Sac Myelopathy (Hirayama Disease, Juvenile Muscular Atrophy of the Distal Upper Limb) This unusual myelopathy has usually been considered with the motor neuron disorders because of its characteristic features of chronic wasting of one hand and forearm without sensory changes or long tract signs Hirayama pointed out that in the young men who were affected, the mechanism of cord damage may be a buckling of the dorsal dural sac and intermittent anterior displacement and ligamentous compression of the cord during exion of the neck The muscles innervated by C7, C8, and T1, encompassing mainly the hand and forearm, are affected on one side or bilaterally, but always asymmetrically There are few or no fasciculations and no sensory changes; the painless loss of power and muscle bulk proceeds smoothly over several years, giving the impression of a degenerative condition MRI or CT myelogram performed with the neck exed, as described by Hirayama and Tokumaru, shows the cervical cord to be atrophic with signal changes in the anterior parts of the cord and con rms the diagnosis of compression by the buckled dura We have examined three such patients in the past 5 years and can corroborate their claim from observation of MRI with the patient placed in a exed-neck position Presumably, this con guration causes ischemia of the anterior gray matter, but this has not been proved Others have reported the syndrome in the absence of this structural con guration (Willeit et al) Two of our patients had long swan-like necks What is most important about this process is the degree of recovery afforded by partial vertebrectomy and by similar surgical approaches that accomplish decompression of the lower cervical cord. convert text to barcode in excel 2003 Steps to Install Font to Generate Barcode In Excel - ExcelChamps
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