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Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_III | Pages 328 - 328
1 Nov 2002
Singh A Crockard. HA
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Introduction: To examine if an individual’s timed walk in sufficiently reproducible to correlate with the degree of spondylitic myelopathy and if surgical decompression has measurement effect on performance.

Methods: A 30mm timed walk, including a turn. The number of paces counted.

Forty-one non-myelopathic individuals were obtained. There was good inter-and intra-observer reliability.

Age matched with 41 patients referred to five neurosurgeons with spondylitic myelopathy were measured prior to surgery and at three, six, twelve, and twenty-four months postoperatively.

Results: The mean control walking time and steps was 64.7 ± 8.4 seconds 46.9 ± 1.2 steps. The mean patients preoperative walking time and steps was 85.4 ± 11.2 seconds; 74.8 ± 5.3 steps and postoperative 64.7 ± 8.4 seconds; 63.5 ± 4.2 steps.

Significant improvement following surgery (p = 0.0018 and p = 5.87 x 10−6 respectively) and improvement maintained for at least two years after surgery.

Discussion and Conclusions:

The test is reproducible and reliable with good sensitivity and specificity.

It shows validity and relevance when compared to other functional scales such as Myelopathy Disability and Nurick.

Changes following surgery can be measured.

A multi-centered trial is recommended.


The Journal of Bone & Joint Surgery British Volume
Vol. 79-B, Issue 5 | Pages 820 - 823
1 Sep 1997
Madawi AA Solanki G Casey ATH Crockard HA

Transarticular screws at the C1 to C2 level of the cervical spine provide rigid fixation, but there is a danger of injury to a vertebral artery. The risk is related to the technical skill of the surgeon and to variations in local anatomy.

We studied the grooves for the vertebral artery in 50 dry specimens of the second cervical vertebra (C2). They were often asymmetrical, and in 11 specimens one of the grooves was deep enough to reduce the internal height of the lateral mass at the point of fixation to ≤2.1 mm, and the width of the pedicle on the inferior surface of C2 to ≤2 mm. In such specimens, the placement of a transarticular screw would put the vertebral artery at extreme risk, and there is not enough bone to allow adequate fixation.

Before any decision is made concerning the type of fixation to be used at C2 we recommend that a thin CT section be made at the appropriate angle to show both the depth and any asymmetry of the grooves for the vertebral artery.


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 2 | Pages 307 - 313
1 Mar 1996
Ransford AO Crockard HA Stevens JM Modaghegh S

In 17 patients (eleven males, six females) with Morquio-Brailsford syndrome (mucopolysaccharidosis IV) we have used onlay femoral and tibial autografts placed posteriorly and secured to the laminae of C1 and C2 to obtain satisfactory occipito-C1/C2 posterior fusion. They were immobilised postoperatively in a halo-plaster body jacket for four months. The age at operation varied between three and 28 years. Those with myelopathic symptoms of recent onset made some recovery, but severely myelopathic patients showed little or no recovery.

We advise prophylactic occipitocervical fusion in these patients since the cartilaginous dens is not strong enough to ensure atlanto-axial mechanical stability.