• MeSH
• bolesti zad chirurgie   etiologie   klasifikace   terapie   MeSH
• chronická nemoc MeSH
• ošetřovatelská diagnóza MeSH
• ošetřovatelská péče MeSH
• pooperační péče MeSH
• předoperační péče MeSH
• spinální stenóza chirurgie   patofyziologie   terapie   MeSH
• spondylartritida chirurgie   patofyziologie   terapie   MeSH
• spondylóza chirurgie   patofyziologie   terapie   MeSH
• výhřez meziobratlové ploténky chirurgie   patofyziologie   terapie   MeSH
• záda patologie   MeSH

• MeSH
• chirurgická dekomprese metody   MeSH
• komorbidita MeSH
• kvalita života MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• multicentrické studie jako téma MeSH
• nemoci míchy * diagnóza   etiologie   chirurgie   MeSH
• neurodegenerativní nemoci diagnóza   etiologie   chirurgie   MeSH
• ortopedické výkony * metody   MeSH
• prognóza * MeSH
• prospektivní studie MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• spondylóza diagnóza   etiologie   chirurgie   MeSH
• statistika jako téma MeSH
• věkové faktory MeSH
• výsledky a postupy - zhodnocení (zdravotní péče) normy   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY: The aim of the study was to measure the sensorimotor brain adaptation activity, shown on functional magnetic resonance images (fMRI), in relation to the degree and extent of spinal cord compression or cervical spondylotic myelopathy (CSM) detected by cervical spine MRI. MATERIAL AND METHODS: Twenty-one patients (average age, 57 years; 9 men and 12 women) with anterior cervical cord compression detected on cervical MRI scans were included. On the images, the degree of spinal canal stenosis, the spinal cord compression based on the antero-posterior diameter of the spinal canal and on transverse areas of the cervical spinal cord and cervical spinal canal, and changes in spinal cord signal intensity were identified. Clinical examination included neurological status, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) and pain intensity assessment using the Visual Analogue Scale (VAS). Electrophysiological tests involving motor evoked and sensory evoked potential (MEP and SEP) recording were conducted and, using fMRI, brain activity during movement of both arms was measured. Based on the transverse spinal cord area of above or below 70 mm2, the patients were placed into two subgroups. According to changes in spinal cord signal intensity, the patients were included into three subgroups with normal findings, incipient myelopathy and advanced myelopathy, respectively. Surgery was carried out from the anterior approach and involved cervical disc replacement. All examinations were performed again at 6 months after surgery. Pre- and post-operative results were compared within each set of subgroups and statistically evaluated. RESULTS: The average pre-operative values were found to increase post-operatively as follows: from 6.4 mm to 8.9 mm (by 39%) for the antero-posterior diameter of the spinal canal; from 129.3 mm2 to 162.8 mm2 (by 26%) for the transverse area of the spinal canal; from 72.6 mm2 to 87.4 mm2 (by 20%) for the transverse spinal cord area; and from 16.3 to 17.4 for the JOA score. The average NDI decreased from 37.9 to 23.7 and the average VAS fell from 6.4 to 1.5. All patients with the change of spinal cord signal that indicated advanced myelopathy also had relevant pathological findings on MEP/SEP examination and this was statistically significant. There was no significant difference in fMRI scans between the two subgroups established on the basis of transverse spinal cord area measurements. In the patients grouped by a change in spinal cord signals, the pre-operative fMRI showed a significantly higher brain activation volume in the subgroup with advanced myelopathy, as compared with the two other subgroups. Surgery resulted in a moderate reduction of the volume of active brain tissue in all three groups. In the patients with advanced myelopathy evaluated in relation to local changes in brain activation, surgery led to a significant decrease in activation volumes in the ipsilateral primary motor cortex and cerebellar hemisphere. There was also a significant increase in activation of the contralateral supplementary motor cortex. DISCUSSION: It is evident that the brain responds to spinal cord damage by increased activity, but with a certain delay. A slightly altered spinal cord signal intensity, such as in incipient myelopathy, apparently does not result in brain activation. On the other hand, significant changes in signal intensity in advanced myelopathy are related to deterioration of spinal cord function, as shown by MEP and SEP examination results, and an increase in both the volume and intensity of cortical motor activation as a compensation mechanism for myelopathy. CONCLUSIONS Hyperintense spinal cord signals on T2-weighted images correlated with the pathological spinal cord function detected by electrophysiological test in all patients. The transverse spinal cord area (around 70 mm2) showed no significant correlation with either sensory and motor brain adaptations or the results of SEP and MEP testing; therefore, as a criterion for indication to surgery it is of no value. The patients with advanced myelopathy, as detected by spinal cord MRI, had a significantly higher pre-operative cortical motor activation on fMRI than patients with normal findings or those with incipient myelopathy. In addition, the patterns of cortical motor activation altered significantly at 6 months after spinal cord decompression, which was shown by an increase or decrease in activation of the relevant motor cortex areas.

• MeSH
• chirurgická dekomprese MeSH
• komprese míchy patologie   patofyziologie   chirurgie   MeSH
• krční obratle patologie   patofyziologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• motorické evokované potenciály MeSH
• senioři MeSH
• somatosenzorické evokované potenciály MeSH
• spondylóza patologie   patofyziologie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Cervical spondylotic myelopathy (CSM) can lead to significant disability through a spectrum of clinical manifestations ranging from dexterity loss to more profound weakness, incontinence and paralysis. AIM: To determine the outcome of surgical decompression for CSM and investigate pre-operative predictors of outcome. METHODS: Prospectively collected data on all patients who underwent decompressive surgery for CSM and completed 12-month follow-up were reviewed. Data on age, MRI T1 and T2 signal changes pre-operatively, surgical approach and the Nurick's Myelopathy Grade (NMG) was analysed pre-operatively and 1 year post-surgery. RESULTS: Data on 93 consecutive patients who underwent surgery for CSM were reviewed. Median age was 62 (23-94) years and 59% were male. The median follow-up was 37 (17-88) months. The approach was anterior in 38 (42%) patients, posterior in 55 (58%); improvement was not significantly different when the two groups were compared. The number of levels decompressed increased with age (p value <0.0001). The group with a pre-operatively high signal on T1-weighted MRI images [n = 28 (30%)] was associated with less neurological recovery post-operatively compared to the patients with a normal T1 cord signal. None of the patients deteriorated neurologically post-operatively, while 66% improved by at least one NMG. CONCLUSION: Surgical decompressions for CSM stop the progress of symptoms at 12 months post-surgery and may result in a significant improvement of NMG in two-thirds of the patients. Changes in the T1-weighted MRI images predict worse outcomes following surgery.

• MeSH
• chirurgická dekomprese metody   MeSH
• dospělí MeSH
• krční obratle chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• mladý dospělý MeSH
• nemoci míchy diagnóza   chirurgie   MeSH
• prediktivní hodnota testů MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylóza chirurgie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Hlavním cílem práce bylo zhodnocení kortikálních senzorimotorických adaptací na fMRI (functional magnetic resonance imaging) mozku u pacientů před a po přední dekompresi míchy při CSM (cervikální spondylogenní myelopatie). Materiál a metodika: Do studie byli zařazeni pacienti s průkazem myelopatických změn a přední komprese míchy při stenóze nebo hernii disku na MRI krční páteře. Byla zhodnocena míra stenózy páteřního kanálu před a 3 měsíce po operaci. Operace krční páteře byly provedeny na jednom až dvou segmentech z předního přístupu s aplikací radiolucentního implantátu, bez fixace dlahou. Každý pacient podstoupil dvě sezení fMRI mozku na 1,5 Tesla přístroji, jedno před chirurgickou intervencí a druhé 6 měsíců po intervenci. V průběhu funkčního vyšetření pacienti prováděli v rámci blokové úlohy akustickými signály řízenou flexi a extenzi zápěstí zvlášť na obou končetinách. Statistické vyhodnocení získaných dat jsme provedli pomocí obecného lineárního modelu implementovaného v nástroji FEAT 6.00 (FMRI Expert Analysis Tool) ze softwarového balíku FSL 5.0 (FMRIB Software library). Rozdíly před a po chirurgické intervenci jsme hodnotili pomocí párového t-testu a výsledné statistické mapy zobrazující Z skóre (standardizovanou hodnotu t-testu) jsme prahovali na korigované hladině významnosti p <0,05. Soubor tvořilo 7 pacientů, z toho bylo 5 žen a 2 muži, s průměrným věkem 55,7 roku. Jako kontrolní soubor byli vyšetřeni pacienti s cervikální spondylogenní radikulopatií. Výsledky: Analýza průměrné skupinové aktivace na fMRI mozku při pohybu oběma končetinami před i po intervenci odhalila významnou aktivaci v dorzálním primárním motorickém kortexu kontralaterálně k aktivní končetině a v přilehlých sekundárních motorických a senzorických oblastech, bilaterálně v oblasti suplementární motorické arey, předního cingula, primárního sluchového kortexu a v oblasti bazálních ganglií, thalamu a mozečku. Po terapii došlo vizuálně ke zmenšení rozsahu aktivací i maximálního Z skóre ve většině uvedených oblastí. Analýza rozdílů mezi oběma vyšetřeními prokázala statisticky významný pokles aktivace při pohybu oběma končetinami v pravostranném parietálním operkulu a v zadní části temporálního laloku. Při pohybu levým zápěstím došlo navíc k poklesu aktivace v pravostranném lobulus parietalis superior, gyrus supramarginalis, inzulárním kortexu a centrálním operkulu. Naproti tomu při pohybu pravým zápěstím došlo k významnému poklesu v levostranném gyrus temporalis medius. Závěr: Průměrný rozdíl předozadního rozměru páteřního kanálu před a po přední operaci stenózy byl 2,67 mm a představoval zvětšení o 40 %, plocha páteřního kanálu se operací zvýšila o 37 % a plocha míchy o 36 %. Funkční MRI mozku u pacientů s CSM prokázala významnou aktivaci zejména v primárním a sekundárním motorickém kortexu a senzorických oblastech. Po chirurgické dekompresi míchy došlo vizuálně ke zmenšení rozsahu aktivací i maximálního Z skóre ve většině oblastí. Prokázali jsme, že pacienti s MRI projevy myelopatie, přitom v klinicky dosud nezávažném stadiu onemocnění, reagovali podle fMRI mozku na operační zákrok poklesem korové aktivace.

Introduction: The aim of this project was to compare and evaluate cortical sensorimotor adaptations as measured by brain fMRI (functional magnetic resonance imaging) in patients before and after surgery for cervical spondylotic myelopathy (CSM), i.e., after spinal cord decompression. Material and methods: Study inclusion required evidence of CSM on MRI of the cervical spine, anterior compression of the spinal cord by osteophytes, or disc herniation. We measured the antero-posterior diameter of the spinal canal stenosis before and 3 months after surgery. Surgery was performed at one or two levels from the anterior approach with implantation of radiolucent spacers, without plate fixation. Each participant underwent two fMRI brain examinations, the first one preoperatively and the second one 6 months following surgery. Subjects performed acoustically paced repetitive wrist flexion and extension of each upper extremity according to block design. MRI data were acquired using 1.5 Tesla scanners. Statistical analysis was carried out using the general linear model implemented in FEAT 6.00 (FMRI Expert Analysis Tool), part of the FSL 5.0 package (FMRIB Software Library). The group differences were evaluated using paired t-test and the resulting statistical maps evaluated as Z-score (standardised value of the t-test) were thresholded at a corrected significance level of p <0.05. The study group consisted of 7 patients including 5 female and 2 male patients, with the average age of 55.7 years. Patients with cervical spondylogenous radiculopathy were evaluated as a control group. Results: The analysis of mean group effects in brain fMRI during flexion and extension of both wrists revealed significant activation in dorsal primary motor cortex contralaterally to the active extremity and in adjacent secondary motor and sensory areas, bilaterally in supplementary motor areas, the anterior cingulum, primary auditory cortex, in the region of the basal ganglia, thalamus and cerebellum. After surgery, the cortical activations and maximum Z-scores decreased in most areas. Analysis of differences between sessions before and after surgery showed a statistically significant activation decrease during movement of both extremities in the right parietal operculum and the posterior temporal lobe. During left wrist movement, there was additional activation decrease in the right superior parietal lobe, the supramarginal gyrus, insular cortex, and the central operculum. In contrast, an activation decrease was detected in the left middle temporal gyrus during right wrist movement. Conclusion: An average difference of anteroposterior cervical spinal canal distance before and after surgery of CSM was 2.67 millimetres, representing a 40% increase; the cross-sectional area of the spinal canal increased by 37% and that of the spinal cord by 36%. Functional MRI of the brain revealed significant activation especially in primary and secondary motor cortex and sensory areas in patients with CSM. After surgical decompression of the spinal cord, cortical activations and maximum Z-score decreased in the majority of areas. We proved decreased cortical activation on functional MRI of the brain after surgery in patients with CSM (evaluated according to MRI of cervical spine), even at an initial stage of the disease.

• Klíčová slova
• kortikální reorganizace,
• MeSH
• chirurgická dekomprese * MeSH
• evokované potenciály MeSH
• komprese míchy * diagnóza   chirurgie   patofyziologie   MeSH
• krční obratle chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• mícha anatomie a histologie   fyziologie   MeSH
• motorické korové centrum * fyziologie   MeSH
• nemoci míchy diagnóza   chirurgie   patofyziologie   MeSH
• neuroplasticita MeSH
• obnova funkce MeSH
• páteřní kanál anatomie a histologie   fyziologie   MeSH
• prospektivní studie MeSH
• psychomotorický výkon MeSH
• senioři MeSH
• somatosenzorické korové centrum * fyziologie   MeSH
• spinální stenóza diagnóza   chirurgie   patofyziologie   MeSH
• spondylóza diagnóza   chirurgie   patofyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE OF THE STUDY: The aim of this prospective study was to evaluate clinical and radiographic results in the patients who underwent L5-S1 fixation using the technique of percutaneous lumbar interbody fusion (AxiaLIF). MATERIAL: The study comprised 23 patients, 11 women and 12 men, who ranged from age of 21 to 63 years, with an average of 48.2 years. In all patients surgical posterior stabilisation involving the L5-S1 segment had previously been done. The initial indications for surgery were L5-S1 spondylolisthesis in 20 and L5-S1 spondylosis and stenosis in three patients. METHODS: The AxiaLIF technique for L5-S1 fixation was indicated in overweight patients and in those after repeated abdominal or retroperitoneal surgery. A suitable position and shape of the sacrum or lumbosacral junction was another criterion. The patients were evaluated between 26 and 56 months (average, 40.4 months) after primary surgery and, on the basis of CT and radiographic findings, bone union and lumbosacral junction stability were assessed. The clinical outcome was investigated using the ODI and VAS systems and the results were statistically analysed by the Wilcoxon test for paired samples with statistical significance set at a level of 0.05. RESULTS: The average VAS value was 6.6 before surgery and, after surgery, 5.2 at three months, 4.2 at six months, 3.1 at one year, 2.9 at two years and 2.1 at three years (n=18). At two post-operative years, improvement in the VAS value by 56.1% was recorded. The average pre-operative ODI value was 25.1; the post-operative values were 17.0 at six months, 12.3 at one year, 10.6 at two years and 8.2 at three years (n=18). At two years after surgery the ODI value improved by 57.8%. To the question concerning their willingness to undergo, with acquired experience, surgery for the same diagnosis, 21 patients (91.3%) gave an affirmative answer. Neither screw breakage nor neurovascular damage or rectal injury was found. CT scans showed complete interbody bone fusion in 22 of the 23 patients (95.6%), In one patient the finding was not clear. Also, posterolateral fusion was achieved in all but one patients (95.6%). A stable L5-S1 segment was found in all patients at all follow-up intervals. The improvement in both VAS and ODI values was statistically significant. DISCUSSION: In addition to indications usual in degenerative disc disease, overweight patients, those who had repeated trans- or retroperitoneal surgery in the L5-S1 region or who underwent long posterior fixation to stabilise the caudal margin of instrumentation are indicated for the AxiaLIF procedure. The clinical results of our study are in agreement with the conclusions of other studies and are similar to the outcomes of surgery using other types of fusion or dynamic stabilisation for this diagnosis. The high rate of fusion in our group is affected by use of a rigid transpedicular fixator together with posterolateral arthrodesis. On the other hand, no negative effects of only synthetic bone applied to interbody space were recorded. CONCLUSIONS: The percutaneous axial pre-sacral approach to the L5-S1 interbody space with application of a double-treaded screw is another option for the management of this much strained segment. The technique is useful particularly when contraindications for conventional surgical procedures are present in patients with anatomical anomalies, in overweight patients or in those who have had repeated surgery in the region. Clinical outcomes and the success rate for L5-S1 bone fusion are comparable with conventional techniques. Complications are rare but their treatment is difficult.

• MeSH
• bederní obratle radiografie   chirurgie   MeSH
• fúze páteře metody   MeSH
• křížová kost radiografie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• obezita komplikace   MeSH
• prospektivní studie MeSH
• senioři MeSH
• spinální stenóza komplikace   radiografie   chirurgie   MeSH
• spondylolistéza komplikace   radiografie   chirurgie   MeSH
• spondylóza komplikace   radiografie   chirurgie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

Bolest bederní páteře patří k onemocněním s velmi častým výskytem. Pacienti s těmito bolestmi velmi často postupně navštěvují řadu lékařů různých oborů v naději, že naleznou pomoc. Předkládaná monografie proto přináší komplexní pohled na tuto problematiku. Editor záměrně požádal o odborné tematické příspěvky zástupce všech zainteresovaných lékařských specializací.Četnost výskytu bolesti páteře potvrzuje, že jde o celosvětově významný nejen medicínský, ale i sociálně-ekonomický problém. Navíc výsledky léčby nebývají tak jednoznačné jako u onemocnění většiny ostatních anatomických oblastí pohybového aparátu a bývají též provázeny vyšším procentem komplikací.Monografie je určena ortopedům, chirurgům a traumatologům, ale i diagnostikům, neurologům a fyzioterapeutům věnujícím se problematice poranění pohybového aparátu.

• Klíčová slova
• Chirurgie, ortopedie, traumatologie,
• MeSH
• bederní obratle anatomie a histologie   patofyziologie   MeSH
• chirurgie operační klasifikace   kontraindikace   metody   MeSH
• degenerace meziobratlové ploténky patofyziologie   MeSH
• diagnostické techniky a postupy MeSH
• management nemoci MeSH
• mezioborová komunikace MeSH
• nemoci páteře diagnóza   chirurgie   klasifikace   patofyziologie   terapie   MeSH
• ortopedické výkony metody   MeSH
• pooperační komplikace MeSH
• spondylartritida chirurgie   terapie   MeSH
• spondylolistéza chirurgie   terapie   MeSH
• spondylóza chirurgie   terapie   MeSH

• NLK Obory
• ortopedie

• MeSH
• bederní obratle anatomie a histologie   patofyziologie   MeSH
• chirurgie operační klasifikace   kontraindikace   metody   MeSH
• degenerace meziobratlové ploténky patofyziologie   MeSH
• diagnostické techniky a postupy MeSH
• management nemoci MeSH
• mezioborová komunikace MeSH
• nemoci páteře diagnóza   chirurgie   klasifikace   patofyziologie   terapie   MeSH
• ortopedické výkony metody   MeSH
• pooperační komplikace MeSH
• spondylartritida chirurgie   terapie   MeSH
• spondylolistéza chirurgie   terapie   MeSH
• spondylóza chirurgie   terapie   MeSH

• Konspekt
• Ortopedie. Chirurgie. Oftalmologie
• NLK Obory
• ortopedie
• NLK Publikační typ
• kolektivní monografie

PURPOSE OF THE STUDY: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in patients over 60 years old. Symptoms often develop gradually and insidiously and are characterized by neck stiffness, arm pain, numbness and clumsiness of hands, as well as weakness of the hands and legs frequently leading to a change in mobility. Surgery is performed primarily to prevent the progression of symptoms but also with the aim of improving existing symptoms. Aim of our study was to assess the outcomes and potential complications of surgical decompression of cervical spondylotic myelopathy (CSM). MATERIAL AND METHODS: Prospective data was collected from 71 patients who were treated surgically for CSM over a four-year period (June 2006 to June 2010). Only patients with confirmed spondylotic cervical myelopathy were included in the study; those with an inflammatory, infectious or neoplastic etiology were excluded. The Nurick scale was used as a primary outcome measure, and the improvement in upper limb function as a secondary outcome measure. Statistical significance was assessed using the paired t-test. RESULTS: 34/71 (47.9%) patients had an anterior decompression, 36/71 (50.7%) patients underwent posterior surgery and one patient (1.4%) received a combined approach: The Nurick score: The mean score improved by 0.9 from 2.4 preoperatively to 1.5 postoperatively for the whole series. Three patients were able to return to work. The preoperative Nurick score showed a positive correlation with the postoperative Nurick score at one year (Pearson Coefficient = 0.85). Upper limb symptoms: Postoperatively, 24 patients were free of any upper limb involvement compared with 6 patients preoperatively. The main improvement was in patients who prior to surgery had subjective symptoms with no objective signs of weakness or muscle wasting. 35/48 (72.9%) of this group showed improvement compared to 7/17 (41.2%) of patients who demonstrated objective weakness and/or wasting preoperatively. COMPLICATIONS: The overall rate of complications was 18.2%. There were two mortalities as a result of pneumonia (2.8%), one patient had to be transferred to the intensive care unit for cardiac failure (1.4%), fixation failure occurred in two patients (2.8%), worsening of myelopathy occurred in two patients (2.8%), C5 temporary radiculopathy presented in two patients (2.8%), superficial wound infection developed in one patient (1.4%) and three patients (4.2%) complained of severe axial pain in the postoperative period. DISCUSSION Our results demonstrate that the greater the preoperative disability the greater the final disability is expected to be. Cord signal change, as an indicator of the pathological severity of the disease, correlates with a worse functional outcome. The degree of improvement postoperatively (i.e. the functional change) does not show a significant correlation with the initial preoperative status. It appears however, that there is a better chance of improvement in patients with no objectively detectable weakness or muscle wasting. The rate of complications encountered in this series is comparable with those in the literature, which renders them valid for quoting when considering surgical treatment for CSM. CONCLUSION: Surgical decompression offers a real chance of improvement in the functional outcome of CSM, especially during the earlier stages of the disease. The surgical decision needs to be considered carefully due to the advanced age of the patient population and the greater burden of co-morbidities, which increase the surgical risks significantly.

• MeSH
• chirurgická dekomprese škodlivé účinky   MeSH
• dospělí MeSH
• krční obratle chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mícha patologie   MeSH
• mladý dospělý MeSH
• pneumonie etiologie   MeSH
• pooperační komplikace MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• spondylóza diagnóza   chirurgie   MeSH
• srdeční selhání etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• chirurgická dekomprese MeSH
• imobilizace MeSH
• komprese míchy chirurgie   patologie   terapie   MeSH
• krční obratle chirurgie   patologie   MeSH
• lidé MeSH
• mícha patofyziologie   MeSH
• nemoci míchy chirurgie   patologie   terapie   MeSH
• prognóza MeSH
• progrese nemoci MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• spondylóza chirurgie   patologie   terapie   MeSH
• stupeň závažnosti nemoci MeSH
• Check Tag
• lidé MeSH