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BACKGROUND AND PURPOSE: Limited data exist on the natural history of thoracic kyphosis in elderly patients. The purpose of this study was to determine the statistical distribution of the thoracic kyphotic angle (TKA) measurement in older patients without vertebral body abnormalities when compared with a young population. METHODS: The TKA was measured by Cobb angle on digital lateral chest radiographs in 90 patients >65 years of age, 60 patients 51–65 years of age, 67 patients 36–50 years of age, and 63 patients 18–35 years of age. Patients with vertebral compression, vertebral body angulation, congenital anomaly, or significant scoliosis were excluded. RESULTS: In patients >65 years of age, average TKA was 41.9°, but the distribution was unexpectedly bimodal, with a low mode at 28.3° and an upper mode at 51.5° (P < .001). Elderly women and men independently demonstrated a bimodal TKA distribution. Two-thirds of elderly women and half of elderly men had a TKA >40° (upper mode). In young patients, average TKA was 26.8°. In middle-aged patients, TKA was intermediate and nonbimodal. CONCLUSION: The TKA distribution in elderly patients (>65 years) without vertebral body abnormality is unexpectedly bimodal (non-normal distribution) with a subpopulation of patients significantly more affected by extreme kyphosis. Extreme thoracic kyphosis therefore occurs independently in a large subset of people, in the absence of vertebral wedge compression. The development of extreme thoracic kyphosis might contribute to excess biomechanical stress in the spine and may identify a population at risk for future vertebral compression fracture in particular at the thoracolumbar junction.

BACKGROUND AND PURPOSE: Occipital neuralgia syndrome can cause severe refractory headaches. In a small percentage of people, these headaches can be devastating and debilitating, with the potential for complete relief following surgical rhizotomy. We describe CT fluoroscopy–guided percutaneous C2–C3 nerve block for the confirmation of diagnosis of occipital neuralgia and for demonstrating to patients the sensory effects of intradural cervical dorsal rhizotomy before the definitive surgical procedure. METHODS: Seventeen patients with occipital neuralgia underwent 32 CT fluoroscopy–guided C2 or C2 and C3 nerve root blocks. Of the 17 patients, nine had occipital neuralgia following prior neck or skull base surgeries. On the basis of the positive results of the nerve blocks in terms of temporary pain relief, all 17 patients underwent unilateral (n = 16) or bilateral (n = 1) intradural C1 (n = 9), C2 (n = 17), C3 (n = 17), or C4 (n = 7) dorsal rhizotomies. All patients were followed up for a mean of 20 months (range, 5–37 months) for assessment of pain relief. Sixteen patients were assessed for degree of satisfaction with and functional state after surgery. RESULTS: All patients had temporary relief of symptoms after percutaneous CT-guided block (positive result) and felt that occipital numbness was an acceptable alternative to pain. Immediately after surgery, all patients had complete relief from pain. At follow-up, 11 patients (64.7%) had complete relief of symptoms, two (11.8%) had partial relief, and four (23.5%) had no relief. Seven of eight (87.5%) patients without prior surgery had complete relief of symptoms and one (12.5%) patient had partial relief, as opposed to complete relief in four of nine (44.4%), partial relief in one of nine (11.2%), and no relief in four of nine (44.4%) patients with a history of prior surgery. Because of the small number of patients, this difference was not statistically significant (P = .110). Eleven of 16 (68.8%) patients stated that the surgery was worthwhile. Eight of 16 (50%) patients felt they were more active and functional after surgery, whereas 25% felt they were either unchanged or less functional than before surgery. None of the patients without a history of prior surgery reported a decreased sense of functional activity following rhizotomy. CONCLUSION: CT fluoroscopy–guided percutaneous cervical nerve block is useful for the confirmation of occipital neuralgia, for demonstrating to patients the sensory effects of nerve sectioning, and possibly as a guide for selection of patients for intradural cervical dorsal rhizotomy. Although not statistically significant, there was a trend toward better response to rhizotomy in patients without prior head or neck surgery.

To investigate the occurrence of neurologic symptomatology in pediatric orthotopic liver transplantation patients and to evaluate the utility of CT in uncovering the origin of their symptoms, we reviewed the medical records and head scans (when performed) of 71 patients. Neurologic problems occurred in 48%; the majority involved seizures, mental status changes, or coma. Patients who only had seizures generally had negative CT scans, except for two patients with minimal subarachnoid hemorrhages. Three-quarters of the comatose patients, however, had significant intracerebral hemorrhages defined by CT. Prominent sulci and ventricles were found in approximately one-third of the patients scanned, but did not correlate with symptomatology or steroid dose.