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Zhao Q, Xie D, Wu H, Wang L, Chen Q, Shi M, Niu B, Yang L. Correlation of spinal cord compression angle and increased signal intensity on MRI in patients with ossification of posterior longitudinal ligament. Sci Rep 2024; 14:17990. [PMID: 39097617 PMCID: PMC11297984 DOI: 10.1038/s41598-024-69100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 07/31/2024] [Indexed: 08/05/2024] Open
Abstract
We retrospectively investigated the correlation between the spinal cord compression angle and increased signal intensity (ISI) in 118 patients with ossification of the posterior longitudinal ligament (OPLL). Patients were analyzed based on the presence and shape of ISI on magnetic resonance imaging. Various indicators, including the spinal cord compression angle, were measured through imaging examinations. Spearman's correlation and logistic regression were used for analyses. Significant positive correlations were observed between the ISI grade and the spinal cord compression angle, maximum spinal canal occupying rate, cervical range of motion, and segmental range of motion. The spinal cord compression ratio and Japanese Orthopaedic Association (JOA) score were negatively correlated with the ISI grade. Regression analysis revealed that the spinal cord compression angle and JOA scores were independent factors that significantly influenced ISI grade. The odds ratio of ISI was 3.858 (95% confidence interval: 0.974-15.278) when comparing the highest and lowest quartiles of the spinal cord compression angle. Patients with a spinal cord compression angle > 35° had more severe imaging manifestations. Thus, a spinal cord compression angle > 35° could serve as a significant indicator of OPLL severity, and greater attention should be focused on treating patients with larger spinal cord compression angles.
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Affiliation(s)
- Qi Zhao
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Dong Xie
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
- Department of Orthopaedics, PLA Navy No. 905 Hospital, Shanghai, 200052, China
| | - Hao Wu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
- Department of Orthopaedics, PLA Navy No. 905 Hospital, Shanghai, 200052, China
| | - Longqing Wang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Qing Chen
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Mingliang Shi
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Baocheng Niu
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China
| | - Lili Yang
- Spine Center, Department of Orthopaedics, Shanghai Changzheng Hospital, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China.
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Türk Börü Ü, Kadir Sarıtaş Z, Görücü Özbek F, Bölük C, Acar H, Koç Y, Zeytin Demiral G. Alterations in the spinal cord, trigeminal nerve ganglion, and infraorbital nerve through inducing compression of the dorsal horn region at the upper cervical cord in trigeminal neuralgia. Brain Res 2024; 1832:148842. [PMID: 38447599 DOI: 10.1016/j.brainres.2024.148842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Idiopathic trigeminal neuralgia (TN) cases encountered frequently in daily practice indicate significant gaps that still need to be illuminated in the etiopathogenesis. In this study, a novel TN animal model was developed by compressing the dorsal horn (DH) of the upper cervical spinal cord. METHODS Eighteen rabbits were equally divided into three groups, namely control (CG), sham (SG), and spinal cord compression (SCC) groups. External pressure was applied to the left side at the C3 level in the SCC group. Dorsal hemilaminectomy was performed in the SG, and the operative side was closed without compression. No procedure was implemented in the control group. Samples from the SC, TG, and ION were taken after seven days. For the histochemical staining, damage and axons with myelin were scored using Hematoxylin and Eosin and Toluidine Blue, respectively. Immunohistochemistry, nuclei, apoptotic index, astrocyte activity, microglial labeling, and CD11b were evaluated. RESULTS Mechanical allodynia was observed on the ipsilateral side in the SCC group. In addition, both the TG and ION were partially damaged from SC compression, which resulted in significant histopathological changes and increased the expression of all markers in both the SG and SCC groups compared to that in the CG. There was a notable increase in tissue damage, an increase in the number of apoptotic nuclei, an increase in the apoptotic index, an indication of astrocytic gliosis, and an upsurge in microglial cells. Significant increases were noted in the SG group, whereas more pronounced significant increases were observed in the SCC group. Transmission electron microscopy revealed myelin damage, mitochondrial disruption, and increased anchoring particles. Similar changes were observed to a lesser extent in the contralateral spinal cord. CONCLUSION Ipsilateral trigeminal neuropathic pain was developed due to upper cervical SCC. The clinical finding is supported by immunohistochemical and ultrastructural changes. Thus, alterations in the DH due to compression of the upper cervical region should be considered as a potential cause of idiopathic TN.
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Affiliation(s)
- Ülkü Türk Börü
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
| | - Zülfükar Kadir Sarıtaş
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Fatma Görücü Özbek
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Cem Bölük
- Department of Neurology and Clinical Neurophysiology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.
| | - Hakan Acar
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
| | - Yusuf Koç
- Department of Surgery, Faculty of Veterinary Medicine, University of Afyon Kocatepe, Afyonkarahisar, Turkey
| | - Gökçe Zeytin Demiral
- Department of Neurology University of Afyonkarahisar Health Sciences, Afyonkarahisar, Turkey
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Wu K, Li H, Xie Y, Zhang S, Wang X. Fractional amplitude of low-frequency fluctuation alterations in patients with cervical spondylotic myelopathy: a resting-state fMRI study. Neuroradiology 2024; 66:847-854. [PMID: 38530417 DOI: 10.1007/s00234-024-03337-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE We sought to use the fractional amplitude of low-frequency fluctuation (fALFF) method to investigate the changes in spontaneous brain activity in CSM patients and their relationships with clinical features. METHODS We recruited 20 patients with CSM, and 20 healthy controls (HCs) matched for age, sex, and education status. The fALFF method was used to evaluate the altered spontaneous brain activities. The Pearson correlation analysis of fALFF and the clinical features were carried out. RESULTS Compared with HC, CSM group showed increased fALFF values in the left middle frontal gyrus, inferior parietal lobule, and right angular gyrus. Decreased fALFF values were found in the right lingual gyrus, cuneus (P < 0.05). Pearson correlation analysis shows that the fALFF values of all CSM were positively correlated with JOA score in the right angular gyrus (r = 0.518, P < 0.05). CONCLUSION CSM patients have abnormal fALFF distribution in multiple brain regions and might be an appealing alternative approach for further exploration of the pathological and neuropsychological states in CSM.
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Affiliation(s)
- Kaifu Wu
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Han Li
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Yuanliang Xie
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Shutong Zhang
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China
| | - Xiang Wang
- Department of Radiology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, No. 26, Shengli Street, Wuhan, 430014, China.
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Levy HA, Pinter ZW, Pumford A, Salmons HI, Townsley S, Katsos K, Reed R, Chen S, Abode-Iyamah K, Deen HG, Clarke M, Bydon M, Fogelson JL, Elder BD, Currier B, Freedman BA, Nassr AN, Karamian BA, Sebastian AS. The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2-T2 Posterior Cervical Fusion. Clin Spine Surg 2024:01933606-990000000-00296. [PMID: 38637921 DOI: 10.1097/bsd.0000000000001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To determine whether the C2 exposure technique was a predictor of change in cervical alignment and patient-reported outcomes measures (PROMs) after posterior cervical decompression and fusion (PCDF) for degenerative indications. BACKGROUND In PCDF handling of the C2 posterior paraspinal musculature during the operative approach varies by surgeon technique. To date, no studies have investigated whether maintenance of the upper cervical semispinalis cervicis attachments as compared with complete reflection of upper cervical paraspinal musculature from the posterior bony elements is associated with superior radiographic and clinical outcomes after PCDF. PATIENTS AND METHODS All adult patients who underwent C2-T2 PCDF for myelopathy or myeloradiculopathy at multi-institutional academic centers between 2013 and 2020 were retrospectively identified. Patients were dichotomized by the C2 exposure technique into semispinalis preservation or midline muscular reflection groups. Preoperative and short and long-term postoperative radiographic outcomes (upper cervical alignment, global alignment, and fusion status) and PROMs (Visual Analog Scale-Neck, Neck Disability Index, and Short Form-12) were collected. Univariate analysis compared patient factors, radiographic measures, and PROMs across C2 exposure groups. RESULTS A total of 129 patients met the inclusion/exclusion criteria (73 muscle preservation and 56 muscle reflection). Patients in the muscular preservation group were on average younger (P= 0.005) and more likely to have bone morphogenic protein (P< 0.001) and C2 pars screws (P= 0.006) used during surgery. Preoperative to postoperative changes in C2 slope, C2 tilt, C2-C3 segmental lordosis, C2-C3 listhesis, C0-C2 Cobb angle, proximal junctional kyphosis, ADI, C1 lamina-occiput distance, C2 sagittal vertical axis, C2-C7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 exposure technique. Likewise, there were no significant differences in fusion status, C2-C3 pseudoarthrosis, C2 screw loosening, and complication and revision rates between C2 exposure groups. CONCLUSIONS Preservation of C2 semispinalis attachments versus muscular reflection did not significantly impact cervical alignment, clinical outcomes, or proximal junction complications in long-segment PCDF. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | | | | | | | | | | | | | - Selby Chen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | | | - H Gordon Deen
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| | - Michelle Clarke
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - Brian A Karamian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
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Şerifoğlu L, Etli MU. Prospective Investigation of the Posterior Longitudinal Ligament and Disc Complex after Posterior Stabilization and Decompression Surgery in Patients With Non-OPLL (Ossification of the Posterior Longitudinal Ligament) Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:e384-e389. [PMID: 38302004 DOI: 10.1016/j.wneu.2024.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in adults, primarily from degenerative changes. The efficacy of treatment strategies, especially surgical approaches, remains debated. OBJECTIVE This study aimed to assess the long-term impact of posterior fusion laminectomy on the posterior longitudinal ligament (PLL) thickness, disc complex, and myelomalacia signal changes in CSM patients. METHODS A single-centre, prospective study from January 2020 to December 2021 included CSM patients without ossified posterior longitudinal ligament (OPLL). Magnetic resonance imaging (MRI) data from baseline, 6, and 12 months postoperatively were collected. Measurements on the MRI were performed using the Osirix MD software, focusing on the PLL width, myelopathic foci dimensions, and canal diameter. RESULTS Out of the 82 initially enrolled patients, 64 were considered for analysis. Postoperatively, a significant reduction in PLL width and myelopathic foci dimensions was observed, alongside a considerable increase in the canal diameter. Clinical outcomes based on the Modified Japanese Orthopaedic Association (mJOA) scale also showcased marked improvements post-surgery. CONCLUSIONS Posterior fusion laminectomy effectively reduces anterior pressure in CSM patients. This treatment may represent an optimal surgical approach for selected CSM cases. Furthermore, more extensive studies with extended follow-up are advocated.
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Affiliation(s)
- Luay Şerifoğlu
- Department of Neurosurgery, Ümraniye Training and Research Hospital, Istanbul, Turkey.
| | - Mustafa Umut Etli
- Department of Neurosurgery, Ümraniye Training and Research Hospital, Istanbul, Turkey
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Liang X, Wang X, Chen Y, He D, Li L, Chen G, Li J, Li J, Liu S, Xu Z. Predictive value of intraoperative contrast-enhanced ultrasound in functional recovery of non-traumatic cervical spinal cord injury. Eur Radiol 2024; 34:2297-2309. [PMID: 37707550 DOI: 10.1007/s00330-023-10221-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVES To evaluate the ability of intraoperative CEUS to predict neurological recovery in patients with degenerative cervical myelopathy (DCM). METHODS Twenty-six patients with DCM who underwent laminoplasty and intraoperative ultrasound (IOUS) were included in this prospective study. The modified Japanese Orthopaedic Association (mJOA) scores and MRI were assessed before surgery and 12 months postoperatively. The anteroposterior diameter (APD), maximum spinal cord compression (MSCC), and area of signal changes in the cord at the compressed and normal levels were measured and compared using MRI and IOUS. Conventional blood flow and CEUS indices (time to peak, ascending slope, peak intensity (PI), and area under the curve (AUC)) at different levels during IOUS were calculated and analysed. Correlations between all indicators and the neurological recovery rate were evaluated. RESULTS All patients underwent IOUS and intraoperative CEUS, and the total recovery rate was 50.7 ± 33.3%. APD and MSCC improved significantly (p < 0.01). The recovery rate of the hyperechoic lesion group was significantly worse than that of the isoechoic group (p = 0.016). 22 patients were analysed by contrast analysis software. PI was higher in the compressed zone than in the normal zone (24.58 ± 3.19 versus 22.43 ± 2.39, p = 0.019). ΔPI compress-normal and ΔAUC compress-normal of the hyperechoic lesion group were significantly higher than those of the isoechoic group (median 2.19 versus 0.55, p = 0.017; 135.7 versus 21.54, p = 0.014, respectively), and both indices were moderately negatively correlated with the recovery rate (r = - 0.463, p = 0.030; r = - 0.466, p = 0.029). CONCLUSIONS Signal changes and microvascular perfusion evaluated using CEUS during surgery are valuable predictors of cervical myelopathy prognosis. CLINICAL RELEVANCE STATEMENT In the spinal cord compression area of degenerative cervical myelopathy, especially in the hyperechoic lesions, intraoperative CEUS showed more significant contrast agent perfusion than in the normal area, and the degree was negatively correlated with the neurological prognosis. KEY POINTS • Recovery rates in patients with hyperechoic findings were lower than those of patients without lesions detected during intraoperative ultrasound. • The peak intensity of CEUS was higher in compressed zones than in the normal parts of the spinal cord. • Quantitative CEUS comparisons of the peak intensity and area under the curve at the compressed and normal levels of the spinal cord revealed differences that were inversely correlated to the recovery rate.
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Affiliation(s)
- Xuankun Liang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Xianxiang Wang
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Yanfang Chen
- Outpatient Office, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Danni He
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Lujing Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Guoliang Chen
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jiachun Li
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Jie Li
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China
| | - Shaoyu Liu
- Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
| | - Zuofeng Xu
- Department of Medical Ultrasonics, The Seventh Affiliated Hospital, Sun Yat-Sen University, No. 628 Zhenyuan Road, Shenzhen, 518107, China.
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Mahdavi A, Rasti S. Dynamic Flexion-Extension Magnetic Resonance Imaging of the Cervical Spine: An Evolutionary Tool for Diagnosis and Management of Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:138-147. [PMID: 38246532 DOI: 10.1016/j.wneu.2024.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024]
Abstract
Dynamic problems need dynamic solutions. High motility of the cervical spine causes a common age-related degenerative condition called cervical spondylotic myelopathy (CSM), manifested by neurological impairments. An accurate and reliable diagnosis of CSM is crucial for determining appropriate management strategies. Traditional static magnetic resonance imaging (MRI) has been the gold standard for imaging CSM; however, it may not fully capture dynamic changes during neck movement. Dynamic flexion-extension (DFE) MRI is an innovative imaging technique that allows for real-time visualization of cervical spine motion. This review article aims to scrutinize the role of DFE MRI in assessing CSM, its added value to clinical implementations, and its limitations. Finally, by addressing the knowledge gaps, this survey sheds light on the road ahead to incorporate DFE MRI into a standard version of the practice.
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Affiliation(s)
- Ali Mahdavi
- Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Rasti
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
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Yao YY, Manocha RHK. Delayed diagnosis of cervical myelopathy in an adult with Weaver syndrome. PM R 2024. [PMID: 38529795 DOI: 10.1002/pmrj.13162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 03/27/2024]
Affiliation(s)
| | - Ranita Harpreet Kaur Manocha
- Cumming School of Medicine, University of Calgary, Calgary, Canada
- Division of Physical Medicine & Rehabilitation, University of Calgary, Calgary, Alberta, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Li J, Tian XN, Zhao BG, Wang N, Zhang YJ, Zhang L. Diagnostic value of cervical spine ZOOM-DWI in cervical spondylotic myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1223-1229. [PMID: 38231389 DOI: 10.1007/s00586-023-08110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/18/2024]
Abstract
PURPOSE To investigate the clinical application value of the non-shared incentive diffusion imaging technique (ZOOM-DWI) diagnoses of cervical spondylotic myelopathy (CSM). METHODS 49 CSM patients who presented from January 2022 to December 2022 were selected as the patient group, and 50 healthy volunteers are recruited as the control group. All subjects underwent conventional MRI and ZOOM-DWI of the cervical spine and neurologic mJOA scores in patients with CSM. The spinal ADC values of segments C2-3, C4-5, C5-6, and C6-7 are measured and analyzed in all subjects, with C5-6 being the most severe level of spinal canal compression in the patient group. In addition, the study also analyzes and compares the relationship between the C5-6 ADC value and mJOA score in the patient group. RESULTS The mean ADC shows no significantly different levels in the control group. Among the ADC values at each measurement level in the patient group, except for C4-5 and C6-7 segments are not statistically significant, the remaining pair-wise comparisons all show statistically significant differences (F = 24.368, p < 0.001). And these individuals have the highest ADC value at C5-6. The C5-6 ADC value in the patient group is significantly higher compared with the ADC value in the control group (t = 9.414, p < 0.001), with statistical significance. The ADC value at the patient stenosis shows a significant negative correlation with the mJOA score (r = -0.493, p < 0.001). CONCLUSION Cervical ZOOM-DWI can be applied to diagnose CSM, and spinal ADC value can use as reliable imaging data for diagnosing cervical myelopathy.
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Affiliation(s)
- Jia Li
- Department of Radiology and Nuclear Medicine, The First Hospital of HeBei Medical University, Shijiazhuang City, 050000, China
| | - Xiao-Nan Tian
- Department of CTMRI, The Third Hospital of HeBei Medical University, Shijiazhuang, 050051, China
| | - Bao-Gen Zhao
- Department of Radiology and Nuclear Medicine, The First Hospital of HeBei Medical University, Shijiazhuang City, 050000, China
| | - Ning Wang
- Department of Radiology and Nuclear Medicine, The First Hospital of HeBei Medical University, Shijiazhuang City, 050000, China
| | - Yu-Jin Zhang
- Department of CTMRI, The Third Hospital of HeBei Medical University, Shijiazhuang, 050051, China
| | - Li Zhang
- Department of Radiology and Nuclear Medicine, The First Hospital of HeBei Medical University, Shijiazhuang City, 050000, China.
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Gallagher DO, Taghlabi KM, Bondar K, Saifi C. Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach. Clin Spine Surg 2024; 37:1-8. [PMID: 38285428 DOI: 10.1097/bsd.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/09/2023] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS An extensive literature review was conducted. RESULTS The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.
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Affiliation(s)
- Daniel O Gallagher
- Department of Education, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Kevin Bondar
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Comron Saifi
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
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He H, Fan L, Lü G, Li X, Li Y, Zhang O, Chen Z, Yuan H, Pan C, Wang X, Kuang L. Myth or fact: 3D-printed off-the-shelf prosthesis is superior to titanium mesh cage in anterior cervical corpectomy and fusion? BMC Musculoskelet Disord 2024; 25:96. [PMID: 38279132 PMCID: PMC10811816 DOI: 10.1186/s12891-024-07213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 01/17/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND To find out if three-dimensional printing (3DP) off-the-shelf (OTS) prosthesis is superior to titanium mesh cages in anterior cervical corpectomy and fusion (ACCF) when treating single-segment degenerative cervical spondylotic myelopathy (DCSM). METHODS DCSM patients underwent ACCF from January 2016 to January 2019 in a single center were included. Patients were divided into the 3DP group (28) and the TMC group (23). The hospital stays, operation time, intraoperative blood loss, and the cost of hospitalization were compared. The Japanese Orthopedic Association (JOA) scores and Neck Disability Index (NDI) were recorded pre-operatively, 1 day, 3, 6, 12, and 24 months post-operatively. Radiological data was measured to evaluate fusion, subsidence, and cervical lordosis. Patients were sent with SF-36 to assess their health-related quality of life (HRQoL). RESULTS The differences in operative time, intraoperative blood loss, and hospital stay were not statistically significant between groups (p > 0.05). Postoperative dysphagia occurred in 2 cases in the 3DP group and 3 cases in the TMC group, which all relieved one week later. The difference in improvement of JOA and NDI between the two groups was not statistically significant (p > 0.05). No hardware failure was found and bony fusion was achieved in all cases except one in the 3DP group. The difference in cervical lordosis (CL), fused segmental angle (FSA), mean vertebral height (MVH), and subsidence rates between groups at each follow-up time point was not statistically significant and the results of the SF-36 were similar (p > 0.05). The total cost was higher in the 3DP group with its higher graft cost (p < 0.05). CONCLUSION In treating single-segment DCSM with ACCF, both 3DP OTS prosthesis and TMC achieved satisfactory outcomes. However, the more costly 3DP OTS prosthesis was not able to reduce subsidence as it claimed.
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Affiliation(s)
- Haoyu He
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Fan
- Department of Spinal Surgery, Third Hospital of Changsha, Changsha, Hunan Province, China
| | - Guohua Lü
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xinyi Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Yunchao Li
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ou Zhang
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Zejun Chen
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Hui Yuan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Changyu Pan
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Xiaoxiao Wang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lei Kuang
- Department of Spinal Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
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Ojeda J, Vergara M, Ávila A, Henríquez JP, Fehlings M, Vidal PM. Impaired communication at the neuromotor axis during Degenerative Cervical Myelopathy. Front Cell Neurosci 2024; 17:1316432. [PMID: 38269114 PMCID: PMC10806149 DOI: 10.3389/fncel.2023.1316432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Degenerative Cervical Myelopathy (DCM) is a progressive neurological condition characterized by structural alterations in the cervical spine, resulting in compression of the spinal cord. While clinical manifestations of DCM are well-documented, numerous unanswered questions persist at the molecular and cellular levels. In this study, we sought to investigate the neuromotor axis during DCM. We use a clinically relevant mouse model, where after 3 months of DCM induction, the sensorimotor tests revealed a significant reduction in both locomotor activity and muscle strength compared to the control group. Immunohistochemical analyses showed alterations in the gross anatomy of the cervical spinal cord segment after DCM. These changes were concomitant with the loss of motoneurons and a decrease in the number of excitatory synaptic inputs within the spinal cord. Additionally, the DCM group exhibited a reduction in the endplate surface, which correlated with diminished presynaptic axon endings in the supraspinous muscles. Furthermore, the biceps brachii (BB) muscle exhibited signs of atrophy and impaired regenerative capacity, which inversely correlated with the transversal area of remnants of muscle fibers. Additionally, metabolic assessments in BB muscle indicated an increased proportion of oxidative skeletal muscle fibers. In line with the link between neuromotor disorders and gut alterations, DCM mice displayed smaller mucin granules in the mucosa layer without damage to the epithelial barrier in the colon. Notably, a shift in the abundance of microbiota phylum profiles reveals an elevated Firmicutes-to-Bacteroidetes ratio-a consistent hallmark of dysbiosis that correlates with alterations in gut microbiota-derived metabolites. Additionally, treatment with short-chain fatty acids stimulated the differentiation of the motoneuron-like NSC34 cell line. These findings shed light on the multifaceted nature of DCM, resembling a synaptopathy that disrupts cellular communication within the neuromotor axis while concurrently exerting influence on other systems. Notably, the colon emerges as a focal point, experiencing substantial perturbations in both mucosal barrier integrity and the delicate balance of intestinal microbiota.
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Affiliation(s)
- Jorge Ojeda
- Neuroimmunology and Regeneration of the Central Nervous System Unit, Biomedical Science Research Laboratory, Basic Sciences Department, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Mayra Vergara
- Neuroimmunology and Regeneration of the Central Nervous System Unit, Biomedical Science Research Laboratory, Basic Sciences Department, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Ariel Ávila
- Developmental Neurobiology Unit, Biomedical Science Research Laboratory, Basic Sciences Department, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
| | - Juan Pablo Henríquez
- Neuromuscular Studies Lab (NeSt Lab), Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Michael Fehlings
- Department of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Spinal Program, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
| | - Pia M. Vidal
- Neuroimmunology and Regeneration of the Central Nervous System Unit, Biomedical Science Research Laboratory, Basic Sciences Department, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile
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13
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Liu SEB, Paul D, Phan A, Shah S, Silberstein H, Puvanesarajah V, Rubery P, Mesfin A. Perioperative Complications and Radiographic Outcomes Following Cervical Laminoplasty: A Review of 105 Cases from a Single Academic Center. World Neurosurg 2023; 180:e258-e265. [PMID: 37739170 DOI: 10.1016/j.wneu.2023.09.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE To assess complications and to compare preoperative and postoperative radiographic measures in patients who underwent cervical laminoplasty. METHODS We evaluated patients undergoing cervical laminoplasty between 2011 and 2022 at an academic medical center. Patient demographics, intraoperative and postoperative complications, and preoperative and postoperative radiographic parameters were recorded. RESULTS Of 150 patients undergoing cervical laminoplasty during 2011-2022, 105 met the inclusion criteria. We identified 22 (21.0%) adverse events in 20 patients: 4 intraoperative (3.8%), 10 perioperative (9.5%), and 8 delayed postoperative (7.6%). Among adverse events, 13 (12.4%) were judged to be minor and 9 (8.6%) were judged to be major complications. Revision surgery was required in 6 (5.7%) patients. Both preoperative and postoperative cervical spine radiographic imaging was available in 47 (44.8%) of the 105 patients. Mean preoperative and postoperative C2-7 Cobb angles were 14.7° and 12.3°, respectively (P = 0.04). Mean preoperative and postoperative sagittal vertical axis measurements were 29.2 mm and 33.3 mm, respectively (P = 0.07). Mean preoperative and postoperative T1 slopes were 32.3° and 30.2°, respectively (P = 0.07). CONCLUSIONS Cervical laminoplasty carries a significant risk of adverse events, the majority of which are minor, and has a low rate of reoperation (5.7%). The procedure does not result in significant changes in sagittal vertical axis or T1 slope. Cervical laminoplasty remains a valuable surgical option for selected patients with cervical myelopathy.
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Affiliation(s)
- Serena E B Liu
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David Paul
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Amy Phan
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Shalin Shah
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Howard Silberstein
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Varun Puvanesarajah
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul Rubery
- Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Addisu Mesfin
- Medstar Orthopaedic Institute/Georgetown University School of Medicine, Washington, DC, USA.
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14
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Burile G, Jawade S, Seth N. The Scope of Physiotherapy Rehabilitation in Compressive Myelopathy Managed by Spinal Fusion: A Case Report. Cureus 2023; 15:e48290. [PMID: 38058338 PMCID: PMC10696622 DOI: 10.7759/cureus.48290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Cervical myelopathy is a sequence of alterations that cause etiological ailments such as spondylosis, ossification of the posterior longitudinal ligament, and compression of nerve roots at various levels. The reduced diameter of the vertebral canal is because of degenerative changes in the structure of the disc, along with the formation of osteophytic spurs that compress the surrounding structures, such as nerve roots, at one or more levels. Radiography, CT, MRI, and dynamic study help identify cervical spondylotic myelopathy. Surgical methods such as anterior, posterior, or combined approaches are used to stabilize and potentially improve the subject's neurologic status. The spine's alignment, the number of mobility segments implicated, the morphology, and the location of the spondylotic compression guide surgical decision-making. Cervical spondylotic myelopathy is a condition of the cervical spine that causes narrowing of the spinal canal with symptoms such as neck pain, numbness in the hands, gait problems, and sphincter dysfunction. We present the case of a 52-year-old male diagnosed with compressive myelopathy from C3 to C7 with a history of falling from the bed. On MRI, there were degenerative changes, spondylosis, and compressive myelopathy, and a disc bulge at multiple levels was seen. The patient underwent a spinal fusion at C3 to C7 level followed by structured physical therapy rehabilitation to gain a good recovery and functional independence to improve quality of life.
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Affiliation(s)
- Ghanishtha Burile
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapna Jawade
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikita Seth
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Fotakopoulos G, Georgakopoulou VE, Lempesis IG, Papalexis P, Sklapani P, Trakas N, Spandidos DA, Faropoulos K. Pathophysiology of cervical myelopathy (Review). Biomed Rep 2023; 19:84. [PMID: 37881604 PMCID: PMC10594073 DOI: 10.3892/br.2023.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 10/27/2023] Open
Abstract
Cervical myelopathy is a well-described medulla spinalis syndrome characterized by sensory disorders, such as pain, numbness, or paresthesia in the limbs, and motor disorders, such as muscle weakness, gait difficulties, spasticity, or hyperreflexia. If left untreated, cervical myelopathy can significantly affect the quality of life of patients, while in severe cases, it can cause disability or even quadriplegia. Cervical myelopathy is the final stage of spinal cord insult and can result from transgene dysplasias of the spinal cord, and acute or chronic injuries. Spondylosis is a common, multifactor cause of cervical myelopathy and affects various elements of the spine. The development of spondylotic changes in the spine is gradual during the patient's life and the symptoms are presented at a late stage, when significant damage has already been inflicted on the spinal cord. Spondylosis is widely considered a condition affecting the middle aged and elderly. Given the fact that the population is gradually becoming older, in the near future, clinicians may have to face an increased number of patients with spondylotic myelopathy.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | - Ioannis G. Lempesis
- Department of Pathophysiology, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
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16
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Levy HA, Karamian BA, Adams AJ, Mao JZ, Canseco JA, Mandel J, Gebeyehu TF, Harlamova D, Bhatt SD, Heinle J, Kaye ID, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Impact of Preoperative Symptom Duration on Patient Outcomes After Posterior Cervical Decompression and Fusion. Global Spine J 2023; 13:2463-2470. [PMID: 35324359 PMCID: PMC10538330 DOI: 10.1177/21925682221087735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). METHODS All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6 months, 6 months-2 years, > 2 years). RESULTS Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6 months of preoperative symptoms improved significantly in all PROMs. Patients with 6 months-2 years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2 years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2 years relative to < 6 months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. CONCLUSION Increased duration of preoperative symptoms (> 2 years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms.
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Affiliation(s)
- Hannah A. Levy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander J. Adams
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Z. Mao
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jenna Mandel
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Teleale F. Gebeyehu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daria Harlamova
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shivangi D. Bhatt
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy Heinle
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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17
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Lee JH, Lee YJ, Chang MC, Lee JH. Clinical Effectiveness of Artificial Disc Replacement in Comparison With Anterior Cervical Discectomy and Fusion in the Patients With Cervical Myelopathy: Systematic Review and Meta-analysis. Neurospine 2023; 20:1047-1060. [PMID: 37798997 PMCID: PMC10562247 DOI: 10.14245/ns.2346498.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Cervical myelopathy (CM) describes the compressive cervical spinal cord state, often accompanied by serious clinical condition, by herniated disc or hypertrophied spurs or ligament. Anterior cervical discectomy and fusion (ACDF) has been frequently employed as conventional surgical solution for this CM despite its inherent biomechanical handicap. Alternatively, an artificial disc replacement (ADR) preserves cervical motion while still decompressing the spinal canal and neural foramen. This analysis elaborated to clarify the potential benefits of ADR application to CM over ACDF from the conglomerated results of the past references. METHODS A literature search was performed using MEDLINE, Embase, Cochrane review, and KMbase databases from the studies published until March 2023. Six studies (3 randomized controlled study [RCTs] and 3 non-RCTs) were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random effects model to obtain effect size and its statistical significance. Quality assessment and evidence level were established in accordance with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. RESULTS Among 6 studies, 2 studies showed that ADR group achieved significantly better clinical improvement than the ACDF group, while the rest 4 studies revealed no significant difference. A meta-analysis showed better clinical outcomes with or without statistical significance. The level of evidence was low because of inconsistency and imprecision. CONCLUSION ADR was superior or at least, not inferior to ACDF in terms of functional recovery. However, its application to the CM patients is merely empowered with weak strength due to low level of evidence.
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Affiliation(s)
- Jung Hwan Lee
- Department of Rehabilitation Medicine, Namdarun Rehabilitation Clinic, Yongin, Korea
| | | | - Min Cheol Chang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jun Ho Lee
- Department of Neurosurgery, Kyung Hee University Medical Center, Seoul, Korea
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18
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Rodrigues AJ, Schonfeld E, Varshneya K, Stienen MN, Veeravagu A. The Impact of Preoperative Myelopathy on Postoperative Outcomes among Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population: A Propensity-Score Matched Study. Asian Spine J 2023; 17:693-702. [PMID: 37226379 PMCID: PMC10460652 DOI: 10.31616/asj.2022.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/28/2022] [Accepted: 01/20/2023] [Indexed: 05/26/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for patients diagnosed with cervical degenerative diseases with or without myelopathy. A thorough understanding of outcomes in patients with and without myelopathy undergoing ACDF is required because of the widespread utilization of ACDF for these indications. OVERVIEW OF LITERATURE Non-ACDF approaches achieved inferior outcomes in certain myelopathic cases. Studies have compared patient outcomes across procedures, but few have compared outcomes concerning myelopathic versus nonmyelopathic cohorts. METHODS The MarketScan database was queried from 2007 to 2016 to identify adult patients who were ≤65 years old, and underwent ACDF using the international classification of diseases 9th version and current procedural terminology codes. Nearest neighbor propensity-score matching was employed to balance patient demographics and operative characteristics between myelopathic and nonmyelopathic cohorts. RESULTS Of 107,480 patients who met the inclusion criteria, 29,152 (27.1%) were diagnosed with myelopathy. At baseline, the median age of patients with myelopathy was higher (52 years vs. 50 years, p <0.001), and they had a higher comorbidity burden (mean Charlson comorbidity index, 1.92 vs. 1.58; p <0.001) than patients without myelopathy. Patients with myelopathy were more likely to undergo surgical revision at 2 years (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.54-1.73) or are readmitted within 90 days (OR, 1.27; 95% CI, 1.20-1.34). After patient cohorts were matched, patients with myelopathy remained at elevated risk for reoperation at 2 years (OR, 1.55; 95% CI, 1.44-1.67) and postoperative dysphagia (2.78% vs. 1.68%, p <0.001) compared to patients without myelopathy. CONCLUSIONS We found inferior postoperative outcomes at baseline for patients with myelopathy undergoing ACDF compared to patients without myelopathy. Patients with myelopathy remained at significantly greater risk for reoperation and readmission after balancing potential confounding variables across cohorts, and these differences in outcomes were largely driven by patients with myelopathy undergoing 1-2 level fusions.
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Affiliation(s)
- Adrian John Rodrigues
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Ethan Schonfeld
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Martin Nikolaus Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & Medical School of St.Gallen, St. Gallen,
Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
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19
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Guo L, Li J, Zhang F, Sun Y, Zhang W. Posterior endoscopic decompression combined with anterior cervical discectomy and fusion versus posterior laminectomy and fusion for multilevel cervical spondylotic myelopathy: a retrospective case-control study. BMC Musculoskelet Disord 2023; 24:578. [PMID: 37454072 DOI: 10.1186/s12891-023-06713-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To compare the clinical efficacy of surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) between the hybrid procedure, posterior endoscopic decompression (PED) combined with anterior cervical discectomy fusion (ACDF), and posterior cervical laminectomy and fusion (PCLF). METHODS A retrospective analysis was performed on 38 patients who received surgical treatment for MCSM from January 2018 to December 2021, including 19 cases in hybrid procedure group (13 males and 6 females), followed up for 10 to 22 (12.8 ± 10.3) months, and 19 cases in PCLF group (15 males and 4 females), followed up for 10 to 21 (11.7 ± 8.9) months. Perioperative information, including operation time, intraoperative blood loss, length of hospitalization, and complications, were compared between two groups. Visual analogue scale (VAS) of pain, neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were recorded to evaluate clinical efficacy. Cervical lordosis was calculated by radiographic examination. RESULTS Intraoperative blood loss, length of hospital stay were less in hybrid group than PCLF group, while operation time is longer in hybrid group, with a statistically significant difference (p < 0.05). Increased lordosis was better in hybrid group. There was no significant difference in preoperative VAS, JOA and NDI at pre-operation and final follow-up between two groups. But at post-operation and final follow-up, VAS was less in hybrid group than PCLF group (p < 0.05). There were 2 cases of neurostimulation symptoms in hybrid group, 2 cases of C5 nerve root palsy, 2 cases of subcutaneous fat necrosis and 1 case of dural tear in PCLF group, and all patients relieved with symptomatic treatment. CONCLUSION The hybrid procedure of PED combined with ACDF showed satisfied clinical outcome, with less intraoperative blood loss, shorter length of hospitalization and lower post-operative neck pain than PCLF. It is an effective surgical treatment for MCSM.
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Affiliation(s)
- Lei Guo
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Yapeng Sun
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
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20
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Aljohani S, Alshanqiti M, Alzahrani M. Unexpected Recovery: A Report on the Spontaneous Regression of a Herniated Cervical Disc. Cureus 2023; 15:e41429. [PMID: 37546141 PMCID: PMC10403679 DOI: 10.7759/cureus.41429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
We describe a case in which a herniated cervical disc was compressing the spinal cord. Surgical treatment was offered based on the patient's symptoms and magnetic resonance imaging (MRI), but the patient declined. The patient's symptoms were relieved after 10 months of nonsurgical intervention, and a subsequent MRI revealed that the cervical disc herniation (CDH) had regressed. This phenomenon is well established in the lumbar region but remains rare in the cervical spine. We recommend opting for conservative management and frequent follow-ups for patients with CDH unless they present with a surgical urgency.
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Affiliation(s)
- Sara Aljohani
- Collage of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Maryam Alshanqiti
- Department of Neurosurgery, King Fahad General Hospital, Madinah, SAU
| | - Moajeb Alzahrani
- Department of Neurosurgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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21
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Murata S, Takami M, Endo T, Hashizume H, Iwasaki H, Tsutsui S, Nagata K, Murakami K, Taiji R, Kozaki T, Heller JG, Yamada H. Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2023; 48:702-709. [PMID: 36730659 DOI: 10.1097/brs.0000000000004539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/21/2022] [Indexed: 02/04/2023]
Abstract
STUDY DESIGN A prospective cohort study. OBJECTIVE To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression. MATERIALS AND METHODS We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery. RESULTS The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated. CONCLUSIONS Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Shizumasa Murata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Masanari Takami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Toru Endo
- Department of Orthopaedic Surgery, Endo Clinic, Otsu, Shiga, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Iwasaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Keiji Nagata
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Kimihide Murakami
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Ryo Taiji
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - John G Heller
- Department of Orthopaedic Surgery, The Emory Spine Center, Emory Muskuloskeletal Institute, Atlanta, GA
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Japan
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22
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Mitchell J, Abdelhakim N, Nagib P, Grossbach AJ, Bourekas E, Bhandary S, Bigelow G, Awad H. Reducing the Risk of Spinal Cord Injury in Patients With Asymptomatic Cervical Stenosis Undergoing Cardiac and Vascular Surgery. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00127-1. [PMID: 36966120 DOI: 10.1053/j.jvca.2023.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Affiliation(s)
- Justin Mitchell
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nada Abdelhakim
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Paul Nagib
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Andrew J Grossbach
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric Bourekas
- Department of Neuroradiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Greg Bigelow
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH.
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23
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Kim MW, Kang CN, Choi SH. Update of the Natural History, Pathophysiology, and Treatment Strategies of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2023; 17:213-221. [PMID: 36787787 PMCID: PMC9977993 DOI: 10.31616/asj.2022.0440] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023] Open
Abstract
Cervical myelopathy is a clinical syndrome resulting in symptoms of neurologic deficits due to prolonged spinal cord compression or ischemia in the cervical spine. Spinal cord compression can be caused by ossification of the posterior longitudinal ligament and hypertrophy of ligamentun flavum in addition to degenerative cervical spondylosis, degenerative disc disease, and progressive cervical kyphosis. Degenerative cervical myelopathy (DCM) is a series of disease entities caused by spinal cord compression by various nontraumatic and non-infectious causes. The pathophysiology of DCM includes spinal cord structure and function abnormalities caused by both static and dynamic factors. Surgical decompression for patients with moderate to severe cervical myelopathy not only inhibits the progression of neurological deterioration, but also improves functional status, pain, and quality of life. However, the role of nonsurgical treatment in patients with mild spinal cord compression is controversial. In general, patients with cervical myelopathies who do not undergo surgery have a poor prognosis. Appropriate surgical treatment is recommended when spinal cord compression is confirmed on image study in patients with reasonable symptoms of cervical myelopathy. The patient's overall health, degree of compression, presence of concurrent cervical radiculopathy, and cervical spine alignment, in addition to lesion location and etiology, should be considered when determining an appropriate surgical procedure. This review covers the updated issues, including pathophysiology, clinical manifestations, differential diagnosis, and available treatments for DCM.
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Affiliation(s)
- Min Woo Kim
- Department of Orthopaedic Surgery, Busan Medical Center, Pusan,
Korea
| | - Chang-Nam Kang
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul,
Korea
| | - Sung Hoon Choi
- Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul,
Korea
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24
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Toop N, Gifford CS, McGahan BG, Gibbs D, Miracle S, Schwab JM, Motiei-Langroudi R, Farhadi HF. Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy. J Neurosurg Spine 2023; 38:14-23. [PMID: 35986727 DOI: 10.3171/2022.6.spine2234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) is routinely treated with surgical decompression, but disparate postoperative outcomes are frequently observed, ranging from complete neurological recovery to persistent decline. Although numerous clinical and radiological factors have been independently associated with failure to improve, the relative impact of these proposed risk factors remains obscure. In this study, the authors assess the combined role of clinical and radiographic parameters in contributing to failure to attain neurological improvement after surgery. METHODS A consecutive series of patients who underwent surgery for DCM between July 2013 and August 2018 at a single institution was identified from a prospectively maintained database. Retrospective chart review was undertaken to record perioperative clinical and radiographic parameters. Failure to improve on the last follow-up evaluation after surgery, defined as a change in modified Japanese Orthopaedic Association (mJOA) score less than 2, was the primary outcome in univariate and multivariate analyses. RESULTS The authors included 183 patients in the final cohort. In total, 109 (59.6%) patients improved (i.e., responders with ΔmJOA score ≥ 2) after surgery and 74 (40.4%) were nonresponders with ΔmJOA score < 2. Baseline demographic variables and comorbidity rates were similar, whereas baseline Nurick score was the only clinical variable that differed between responders and nonresponders (2.7 vs 3.0, p = 0.02). In contrast, several preoperative radiographic variables differed between the groups, including presence and degree of cervical kyphosis, number of levels with bidirectional cord compression, presence and number of levels with T2-weighted signal change, intramedullary lesion (IML) length, Torg ratio, and both narrowest spinal canal and cord diameter. On multivariate analysis, preoperative degree of kyphosis at C2-7 (OR 1.19, p = 0.004), number of levels with bidirectional compression (OR 1.83, p = 0.003), and IML length (OR 1.14, p < 0.001) demonstrated the highest predictive power for nonresponse (area under the receiver operating characteristic curve 0.818). A risk factor point system that predicted failure of improvement was derived by incorporating these 3 variables. CONCLUSIONS When a large spectrum of both clinical and radiographic variables is considered, the degree of cervical kyphosis, number of levels with bidirectional compression, and IML length are the most predictive of nonresponse after surgery for DCM. Assessment of these radiographic factors can help guide surgical decision-making and more appropriately stratify patients in clinical trials.
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Affiliation(s)
- Nathaniel Toop
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - Connor S Gifford
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - Ben G McGahan
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - David Gibbs
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - Shelby Miracle
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - Jan M Schwab
- 2Belford Center for Spinal Cord Injury, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rouzbeh Motiei-Langroudi
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
| | - H Francis Farhadi
- 1Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus; and
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25
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Park WT, Min WK, Shin JH, Ko SB, Son ES, Kim J, Jang J, Lee GW. High reliability and accuracy of dynamic magnetic resonance imaging in the diagnosis of cervical Spondylotic myelopathy: a multicenter study. BMC Musculoskelet Disord 2022; 23:1107. [PMID: 36536358 PMCID: PMC9764552 DOI: 10.1186/s12891-022-06097-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a critical condition that results in significant neurologic deterioration. An accurate diagnosis is essential for determining its outcome and prognosis. The pathology is strongly associated with dynamic factors; therefore, dynamic magnetic resonance (MR) image could be crucial to accurately detect CSM. However, very few studies have evaluated the reliability and accuracy of dynamic MR in CSM. In this study, we aimed to compare intra- and interobserver reliabilities and accuracy of dynamic MR in detecting CSM using sagittal MR scans of the neck in the flexed, neutral, and extended position. METHODS Out of 131 patients who underwent surgical treatments for CSM, 107 were enrolled in this study. The patient underwent three-types of sagittal MR scans that were obtained separately in different neck positions (neutral, flexion, and extension postures). The MR scans of the cervical spine were evaluated independently by three spine professionals, on the basis of tabled questionnaires. For accuracy, we performed a receiver operator characteristic analysis, and the overall discriminating ability of each method was measured by calculating the area under the ROC curve. The Cohen's kappa coefficient and the Fleiss-generalized kappa coefficient was used to the inter- and intra-observer reliabilities. RESULTS The intraobserver reliability (using the Cohen's kappa coefficient) and interobserver reliability (using the Fless kappa coefficient) were respectively 0.64 and 0.52 for the neutral sagittal MR. The accuracy of neutral sagittal MR in detecting CSM was 0.735 (95% CI, 0.720 to 0.741) while that of extension sagittal MRI was 0.932 (96% CI, 0.921 to 0.948). CONCLUSIONS Dynamic MR significantly showed better diagnostic reliability and accuracy in detecting CSM compared to conventional MR. In particular, extension MR scans could provide a more accurate diagnosis than other images.
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Affiliation(s)
- Wook-Tae Park
- grid.413040.20000 0004 0570 1914Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu, 42415 South Korea
| | - Woo-Kie Min
- grid.258803.40000 0001 0661 1556Department of Orthopedic Surgery, Kyungpook National Univeristy, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 South Korea
| | - Ji-Hoon Shin
- Department of Orthopedic Surgery, Pohang Semyeng Christianity Hospital, 94-5 Daedo-dong, Nam-gu, Pohang-si, Gyeonsangbuk-do 37816 South Korea
| | - Sang-Bong Ko
- grid.253755.30000 0000 9370 7312Department of Orthopedic Surgery, Daegu Catholic University, Daegu Catholic University Hospital, 33 Duryugongwon-ro 17-gil, Daemyeong-dong, Nam-gu, Daegu, 42472 South Korea
| | - Eun-Seok Son
- grid.414067.00000 0004 0647 8419Department of Orthopedic Surgery, Keimyung University, Dongsan Medical Center, 1035 Dalgubeol-daero, Sindang-dong, Dalseo-gu, Daegu, 42601 South Korea
| | - Jiyoun Kim
- grid.411145.40000 0004 0647 1110Department of Orthopedic Surgery, Kosin University, Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan, 49267 South Korea
| | - Jihoon Jang
- grid.411145.40000 0004 0647 1110Department of Orthopedic Surgery, Kosin University, Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan, 49267 South Korea
| | - Gun Woo Lee
- grid.413040.20000 0004 0570 1914Department of Orthopedic Surgery, Yeungnam University College of Medicine, Yeungnam University Medical Center, 170 Hyonchung-ro, Namgu, Daegu, 42415 South Korea
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26
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The Natural History of Degenerative Cervical Myelopathy. Clin Spine Surg 2022; 35:396-402. [PMID: 36447343 DOI: 10.1097/bsd.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the most frequent cause of spinal cord dysfunction and injury in the adult population and leads to significant loss of quality of life and economic impact from its associated medical care expenditures and loss of work. Surgical intervention is recommended for patients manifesting progressing neurological signs and symptoms of myelopathy, but the optimal management in individuals who have mild and clinically stable disease manifestations is controversial. Understanding the natural history of DCM is, thus, important in assessing patients and identifying those most appropriately indicated for surgical management. Despite the attempts to rigorously perform studies of the natural history of these patients, most published investigations suffer from methodological weaknesses or are underpowered to provide definitive answers. Investigations of particular patient subsets, however, provide some clinical guidance as to which patients stand most to benefit from surgery, and these may include those with lower baseline mJOA scores, evidence of segmental hypermobility, cord signal changes on MRI, abnormal somatosensory or motor-evoked potentials, or the presence of certain inflammatory markers. Clinicians should assess patients with mild myelopathy and those harboring asymptomatic cervical spinal cord compression individually when making treatment decisions and an understanding of the various factors that may influence natural history may aid in identifying those best indicated for surgery. Further investigations will likely identify how variables that affect natural history can be used in devising more precise treatment algorithms.
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27
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Waddell WH, Vaughan WE, Abtahi AM. Radiographic Parameters in Cervical Myelopathy: Review of Current Literature. Clin Spine Surg 2022; 35:389-395. [PMID: 36346980 DOI: 10.1097/bsd.0000000000001412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN This was a narrative review. OBJECTIVES Provide a comprehensive review of radiographic alignment parameters and their effect on procedure selection, surgical decision-making, and clinical outcomes for the treatment of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA The use of radiographic parameters to predict prognosis and surgical outcomes in patients with CSM is an evolving field given the complex presentation of patients with this condition. METHODS A literature search was conducted using PubMed for surgical treatment of CSM, with an emphasis on cervical radiographic parameters and clinical outcomes. RESULTS The principal goals of spine surgery can be broken down into decompression, stabilization, and restoration of alignment. The principle of restoring balance takes careful preoperative planning and attention to radiographic parameters including cervical lordosis, C2-C7 sagittal vertical axis, neck tilt, thoracic inlet angle, T1 slope, K-line, and modified K-line. Surgical interventions for CSM include anterior cervical discectomy and fusion, posterior cervical fusion, or laminoplasty and careful consideration of radiographic measures guide surgical decision-making is essential to ensure optimal outcomes. CONCLUSION Utilization of key radiographic parameters in surgical planning and decision-making allows surgeons to optimize clinical outcomes for CSM. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
| | | | - Amir M Abtahi
- Department of Orthopaedic Surgery
- Center for Musculoskeletal Research
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
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28
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Electrodiagnostic Studies in Degenerative Cervical Myelopathy. Clin Spine Surg 2022; 35:403-409. [PMID: 36447344 DOI: 10.1097/bsd.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/03/2022] [Indexed: 12/05/2022]
Abstract
The diagnosis of degenerative cervical myelopathy can generally be made with a thorough history, physical examination, and spinal imaging. Electrodiagnostic studies, consisting of nerve conduction studies and electromyography, are a useful adjunct when the clinical picture is inconsistent or there is concern for overlapping pathology. Electrodiagnostic studies may be particularly helpful in identifying cases of myeloradiculopathy, when there is combined nerve root and spinal cord injury, both with regards to prognosis and guiding surgical treatment. Electrodiagnostic studies are a useful adjunct for the spine surgeon and should be used when there are features atypical for degenerative cervical myelopathy or when there is suspicion for a concomitant disease process.
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29
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Li GS, Wang XX, Tan RB, Wang KH, Hu XS, Hu Y. Ultrastructural destruction of neurovascular unit in experimental cervical spondylotic myelopathy. Front Neurosci 2022; 16:1031180. [PMID: 36466180 PMCID: PMC9709118 DOI: 10.3389/fnins.2022.1031180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND AND PURPOSE The pathogenesis of cervical spondylotic myelopathy (CSM) remains unclear. This study aimed to explore the ultrastructural pathology of neurovascular unit (NVU) during natural development of CSM. METHODS A total of 24 rats were randomly allocated to the control group and the CSM group. Basso-Beattie-Bresnahan (BBB) scoring and somatosensory evoked potentials (SEP) were used as functional assessments. Hematoxylin-eosin (HE), toluidine blue (TB), and Luxol fast blue (LFB) stains were used for general structure observation. Transmission electron microscopy (TEM) was applied for investigating ultrastructural characteristics. RESULTS The evident compression caused significant neurological dysfunction, which was confirmed by the decrease in BBB score and SEP amplitude, as well as the prolongation of SEP latency (P < 0.05). The histopathological findings verified a significant decrease in the amount of Nissl body and myelin area and an increase in vacuolation compared with the control group (P < 0.05). The TEM results revealed ultrastructural destruction of NVU in several forms, including: neuronal degeneration and apoptosis; disruption of axonal cytoskeleton (neurofilaments) and myelin sheath and dystrophy of axonal terminal with dysfunction mitochondria; degenerative oligodendrocyte, astrocyte, and microglial cell inclusions with degenerating axon and dystrophic dendrite; swollen microvascular endothelium and loss of tight junction integrity; corroded basement membrane and collapsed microvascular wall; and proliferated pericyte and perivascular astrocytic endfeet. In the CSM group, reduction was observed in the amount of mitochondria with normal appearance and the number of cristae per mitochondria (P < 0.05), while no substantial drop of synaptic vesicle number was seen (P > 0.05). Significant narrowing of microvascular lumen size was also observed, accompanied by growth in the vascular wall area, endothelial area, basement membrane thickness, astrocytic endfeet area, and pericyte coverage area (rate) (P < 0.05). CONCLUSION Altogether, the findings of this study demonstrated ultrastructural destruction of NVU in an experimental CSM model with dorsal-lateral compression, revealing one of the crucial pathophysiological mechanisms of CSM.
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Affiliation(s)
- Guang-Sheng Li
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xu-Xiang Wang
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ron-Bang Tan
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kang-Heng Wang
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiao-song Hu
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yong Hu
- Spinal Division of Orthopaedic and Traumatology Center, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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30
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Croci DM, Sherrod B, Alvi MA, Mummaneni PV, Chan AK, Bydon M, Glassman SD, Foley KT, Potts EA, Shaffrey ME, Coric D, Knightly JJ, Park P, Wang MY, Fu KM, Slotkin JR, Asher AL, Than KD, Gottfried ON, Shaffrey CI, Virk MS, Bisson EF. Differences in postoperative quality of life in young, early elderly, and late elderly patients undergoing surgical treatment for degenerative cervical myelopathy. J Neurosurg Spine 2022; 37:339-349. [PMID: 35276658 DOI: 10.3171/2022.1.spine211157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is a common progressive spine disorder affecting predominantly middle-aged and elderly populations. With increasing life expectancy, the incidence of CSM is expected to rise further. The outcomes of elderly patients undergoing CSM surgery and especially their quality of life (QOL) postoperatively remain undetermined. This study retrospectively reviewed patients to identify baseline differences and validated postoperative patient-reported outcome (PRO) measures in elderly patients undergoing CSM surgery. METHODS The multi-institutional, neurosurgery-specific NeuroPoint Quality Outcomes Database was queried to identify CSM patients treated surgically at the 14 highest-volume sites from January 2016 to December 2018. Patients were divided into three groups: young (< 65 years), early elderly (65-74 years), and late elderly (≥ 75 years). Demographic and PRO measures (Neck Disability Index [NDI] score, modified Japanese Orthopaedic Association [mJOA] score, EQ-5D score, EQ-5D visual analog scale [VAS] score, arm pain VAS, and neck pain VAS) were compared among the groups at baseline and 3 and 12 months postoperatively. RESULTS A total of 1151 patients were identified: 691 patients (60%) in the young, 331 patients (28.7%) in the early elderly, and 129 patients (11.2%) in the late elderly groups. At baseline, younger patients presented with worse NDI scores (p < 0.001) and lower EQ-5D VAS (p = 0.004) and EQ-5D (p < 0.001) scores compared with early and late elderly patients. No differences among age groups were found in the mJOA score. An improvement of all QOL scores was noted in all age groups. On unadjusted analysis at 3 months, younger patients had greater improvement in arm pain VAS, NDI, and EQ-5D VAS compared with early and late elderly patients. At 12 months, the same changes were seen, but on adjusted analysis, there were no differences in PROs between the age groups. CONCLUSIONS The authors' results indicate that elderly patients undergoing CSM surgery achieved QOL outcomes that were equivalent to those of younger patients at the 12-month follow-up.
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Affiliation(s)
- Davide M Croci
- 1Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Brandon Sherrod
- 1Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | | | - Praveen V Mummaneni
- 3Department of Neurosurgery, University of California, San Francisco, California
| | - Andrew K Chan
- 3Department of Neurosurgery, University of California, San Francisco, California
| | - Mohamad Bydon
- 2Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | | | - Kevin T Foley
- 5Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | - Eric A Potts
- 6Department of Neurosurgery, Indiana University; Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Mark E Shaffrey
- 7Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Domagoj Coric
- 8Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Paul Park
- 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Michael Y Wang
- 11Department of Neurosurgery, University of Miami, Miami, Florida
| | - Kai-Ming Fu
- 12Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | | | - Anthony L Asher
- 8Department of Neurosurgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas HealthCare System, Charlotte, North Carolina
| | - Khoi D Than
- 14Department of Neurosurgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 14Department of Neurosurgery, Duke University, Durham, North Carolina
| | | | - Michael S Virk
- 12Department of Neurosurgery, Weill Cornell Medical College, New York, New York
| | - Erica F Bisson
- 1Department of Neurological Surgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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31
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Boerger T, Alsouhibani A, Mowforth O, Hamilton J, Lalkhen A, Davies BM, Kotter MRN. Moving Beyond the Neck and Arm: The Pain Experience of People With Degenerative Cervical Myelopathy Who Have Pain. Global Spine J 2022; 12:1434-1442. [PMID: 33626937 PMCID: PMC9393978 DOI: 10.1177/2192568220986143] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional internet survey of people living with degenerative cervical myelopathy. OBJECTIVE The purpose of this study was to quantify pain distribution, severity, and interference in persons with degenerative cervical myelopathy. METHODS Eighty-two participants with degenerative cervical myelopathy were recruited for this internet survey. This survey utilized the Michigan Body Map and brief pain inventory (BPI) to assess anatomical distribution and severity of pain as well as the patient derived modified Japanese Orthopedic Association scale (p-mJOA) for myelopathic severity and SF-36 for measures of health-related quality of life. Internal consistency was evaluated with Cronbach's alpha. Pearson's correlations were assessed with p-mJOA and SF-36. Multivariate analysis of variance was used to determine if history of prior surgery or concomitant pain diagnosis impacted experience of pain. RESULTS Michigan body map distribution and brief pain inventory severity and interference were correlated with p-mJOA and SF-36 scores (p < 0.05). Pain was moderate to severe in 78% of participants. Pain was commonly widespread. Pain scales were sufficiently internally consistent (α > 0.9). History of surgery or other pain diagnosis did not impact experience of pain in myelopathy. CONCLUSIONS Pain is commonly identifiable in large areas of the body, is frequently moderate to severe in intensity and impacts quality of life and severity of myelopathy in a cohort of individuals with myelopathy who have pain.
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Affiliation(s)
- Timothy Boerger
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Ali Alsouhibani
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Saudi Arabia
| | - Oliver Mowforth
- Department of Clinical Neurosurgery, Academic Neurosurgery Unit, University of Cambridge, Cambridge, UK
| | - Joseph Hamilton
- Department of Clinical Neurosurgery, Academic Neurosurgery Unit, University of Cambridge, Cambridge, UK
| | - Abdul Lalkhen
- Neuromodulation Service Salford Royal NHS Foundation Trust, Salford, UK
| | - Benjamin M. Davies
- Department of Clinical Neurosurgery, Academic Neurosurgery Unit, University of Cambridge, Cambridge, UK
| | - Mark R. N. Kotter
- Department of Clinical Neurosurgery, Academic Neurosurgery Unit, University of Cambridge, Cambridge, UK,Mark R. N. Kotter, Department of Clinical Neurosurgery, Academic Neurosurgery Unit, University of Cambridge, Cambridge CB2 1TN, UK.
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32
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Yu Z, Pan W, Chen J, Peng X, Ling Z, Zou X. Application of electrophysiological measures in degenerative cervical myelopathy. Front Cell Dev Biol 2022; 10:834668. [PMID: 36016659 PMCID: PMC9395596 DOI: 10.3389/fcell.2022.834668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is one of the leading causes of progressive spinal cord dysfunction in the elderly. Early diagnosis and treatment of DCM are essential to avoid permanent disability. The pathophysiology of DCM includes chronic ischemia, destruction of the blood–spinal cord barrier, demyelination, and neuronal apoptosis. Electrophysiological studies including electromyography (EMG), nerve conduction study (NCS), motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) are useful in detecting the presymptomatic pathological changes of the spinal cord, and thus supplementing the early clinical and radiographic examinations in the management of DCM. Preoperatively, they are helpful in detecting DCM and ruling out other diseases, assessing the spinal cord compression level and severity, predicting short- and long-term prognosis, and thus deciding the treatment methods. Intra- and postoperatively, they are also useful in monitoring neurological function change during surgeries and disease progression during follow-up rehabilitation. Here, we reviewed articles from 1979 to 2021, and tried to provide a comprehensive, evidence-based review of electrophysiological examinations in DCM. With this review, we aim to equip spinal surgeons with the basic knowledge to diagnosis and treat DCM using ancillary electrophysiological tests.
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Affiliation(s)
- Zhengran Yu
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Department of Spine Surgery, Orthopedics Center of Guangdong Provincial People’s Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenxu Pan
- Department of Gastroenterology, Guangzhou Women and Children’s Medical Center, Jinan University, Guangzhou, China
| | - Jiacheng Chen
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinsheng Peng
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zemin Ling
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zemin Ling, ; Xuenong Zou, ,
| | - Xuenong Zou
- Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Zemin Ling, ; Xuenong Zou, ,
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Alkosha HM, El Adalany MA, Elsobky H, Zidan AS, Sabry A, Awad BI. Flexion/Extension Cervical MR imaging: A potentially useful Tool for Decision-Making in Patients with Symptomatic Degenerative Cervical Spine. World Neurosurg 2022; 164:e1078-e1086. [DOI: 10.1016/j.wneu.2022.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022]
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Alluri RK, Vaishnav AS, Sivaganesan A, Albert TJ, Huang RC, Qureshi SA. Cervical Disc Replacement for Radiculopathy Versus Myeloradiculopathy: An MCID Analysis. Clin Spine Surg 2022; 35:170-175. [PMID: 35507951 DOI: 10.1097/bsd.0000000000001313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The aim was to compare the minimally clinically important difference (MCID) across multiple patient-reported outcomes (PROs) in patients undergoing cervical disc replacement (CDR) for cervical spondylotic radiculopathy versus myeloradiculopathy. SUMMARY OF BACKGROUND DATA To date, a limited number of studies have demonstrated mostly similar results in patients with cervical spondylotic radiculopathy or myeloradiculopathy undergoing CDR. However, each of these previous studies have focused on statistically significant differences, which may not correlate with patient perceived improvements in outcomes or success. METHODS Patients who underwent 1 or 2-level CDR with radiculopathy versus myeloradiculopathy were identified, and prospectively collected data was retrospectively reviewed. Demographic variables, preoperative diagnosis, and operative variables were collected for each patient. The following PROs were prospectively collected: Neck Disability Index (NDI), visual analog scale (VAS)-Neck, VAS-Arm, Short Form-12 Health Survey (SF-12) Physical Component Score (PCS), SF-12 Mental Component Score (MCS), PROMIS Physical Function (PF). An MCID analysis of PROs for each diagnosis group was performed and the percentage of patients achieving the MCID was compared between the two diagnosis groups. RESULTS Eight-five patients, of which 56% had radiculopathy and 44% had myeloradiculopathy. MCID analysis demonstrated that at 6-week, 12-week, and final postoperative follow-up there was no significant difference in the percentage of patients with radiculopathy or myeloradiculopathy achieving the MCID for each PRO assessed. In both diagnosis groups the percentage of patients achieving the MCID for each PRO continued to increase from the 6-week to final postoperative follow-up except for the SF-12 MCS in patients with myeloradiculopathy. CONCLUSIONS The percentage of patients achieving the MCID was not significantly different at each postoperative period assessed in the radiculopathy and myeloradiculopathy groups treated with CDR. In addition, the percentage of patients achieving the MCID continued to increase from 6 weeks to final follow-up in both groups for almost all PROs assessed.
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Affiliation(s)
| | | | | | - Todd J Albert
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Russel C Huang
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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Valošek J, Bednařík P, Keřkovský M, Hluštík P, Bednařík J, Svatkova A. Quantitative MR Markers in Non-Myelopathic Spinal Cord Compression: A Narrative Review. J Clin Med 2022; 11:2301. [PMID: 35566426 PMCID: PMC9105390 DOI: 10.3390/jcm11092301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023] Open
Abstract
Degenerative spinal cord compression is a frequent pathological condition with increasing prevalence throughout aging. Initial non-myelopathic cervical spinal cord compression (NMDC) might progress over time into potentially irreversible degenerative cervical myelopathy (DCM). While quantitative MRI (qMRI) techniques demonstrated the ability to depict intrinsic tissue properties, longitudinal in-vivo biomarkers to identify NMDC patients who will eventually develop DCM are still missing. Thus, we aim to review the ability of qMRI techniques (such as diffusion MRI, diffusion tensor imaging (DTI), magnetization transfer (MT) imaging, and magnetic resonance spectroscopy (1H-MRS)) to serve as prognostic markers in NMDC. While DTI in NMDC patients consistently detected lower fractional anisotropy and higher mean diffusivity at compressed levels, caused by demyelination and axonal injury, MT and 1H-MRS, along with advanced and tract-specific diffusion MRI, recently revealed microstructural alterations, also rostrally pointing to Wallerian degeneration. Recent studies also disclosed a significant relationship between microstructural damage and functional deficits, as assessed by qMRI and electrophysiology, respectively. Thus, tract-specific qMRI, in combination with electrophysiology, critically extends our understanding of the underlying pathophysiology of degenerative spinal cord compression and may provide predictive markers of DCM development for accurate patient management. However, the prognostic value must be validated in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Radiology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic
- Department of Biomedical Engineering, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Petr Bednařík
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Radiology and Nuclear Medicine, University Hospital Brno, 625 00 Brno, Czech Republic
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, 779 00 Olomouc, Czech Republic; (J.V.); (P.H.)
- Department of Neurology, University Hospital Olomouc, 779 00 Olomouc, Czech Republic
| | - Josef Bednařík
- Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic; (M.K.); (J.B.)
- Department of Neurology, University Hospital Brno, 625 00 Brno, Czech Republic
- Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic
| | - Alena Svatkova
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark;
- Department of Radiology, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, 2650 Hvidovre, Denmark
- Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, 1090 Vienna, Austria
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Puntumetakul R, Chatprem T, Saiklang P, Phadungkit S, Kamruecha W, Sae-Jung S. Prevalence and Associated Factors of Clinical Myelopathy Signs in Smartphone-Using University Students with Neck Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084890. [PMID: 35457756 PMCID: PMC9025230 DOI: 10.3390/ijerph19084890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 01/17/2023]
Abstract
University students have the highest smartphone-use addiction, which coincides with a rising number in instances of neck pain. As the time in smartphone use increases, neck flexion tends to increase. These positions can affect the spinal cord by the direct and indirect mechanisms which lead to cervical myelopathy. Thus, the current study aimed to determine the prevalence and associated factors of clinical myelopathic signs in smartphone-using university students with neck pain. A total of 237 smartphone-using university students with neck pain participated in the study. They were 20 to 25 years old. Their clinical myelopathic signs were evaluated using standardized test procedures. The prevalence of the clinical myelopathic sign was the Trömner sign at 41.35%, the finger escape sign at 28.27%, Hoffmann’s sign at 25.74%, and the inverted supinator sign at 18.14%. Smartphone usage ≥9.15 h per day was associated with ≥1 of a positive clinical myelopathic sign (adjusted OR = 1.85, 95% CI = 1.05 to 3.26, p = 0.05). The current study highlighted that prolonged smartphone usage may affect the spinal cord. Long duration (≥9 h per day) was associated with at least one positive clinical myelopathic sign. Therefore, smartphone-using university students need to keep their duration of smartphone use to less than 9 h per day. More attention should be given to increasing awareness about the importance of having healthy positions when using smartphones and using them for restricted durations in order to control the increasing prevalence of cervical myelopathy among smartphone-using university student in our societies.
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Affiliation(s)
- Rungthip Puntumetakul
- Research Center of Back, Neck, Other Joint Pain, and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (S.P.); (W.K.)
- Correspondence: ; Tel.: +66-83-419-6186
| | - Thiwaphon Chatprem
- Research Center of Back, Neck, Other Joint Pain, and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand;
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (S.P.); (W.K.)
| | - Pongsatorn Saiklang
- Faculty of Physical Therapy, Srinakharinwirot University, Nakhon Nayok 26120, Thailand;
| | - Supaporn Phadungkit
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (S.P.); (W.K.)
| | - Worawan Kamruecha
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand; (S.P.); (W.K.)
| | - Surachai Sae-Jung
- Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand;
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Anterior Cervical Discectomy and Fusion Versus Cervical Disc Replacement in Patients With Significant Cervical Spondylosis. Clin Spine Surg 2022; 35:E327-E332. [PMID: 35213422 DOI: 10.1097/bsd.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim was to compare clinical outcomes in patients with significant cervical spondylosis treated with cervical disc replacement (CDR) compared with anterior cervical discectomy and fusion (ACDF). SUMMARY OF BACKGROUND DATA As CDR utilization has increased over the past decade, recent studies have investigated the outcomes of CDR in patients with more significant spondylotic changes and demonstrated improved postoperative patient-reported outcomes (PROs). However, no prior study has investigated clinical outcomes of patients with significant spondylotic changes treated with CDR in comparison to ACDF. METHODS Patients who underwent 1-level or 2-level CDR or ACDF with significant cervical spondylosis, quantified using a validated grading scale, were identified, and prospectively collected data was retrospectively reviewed. The following PROs were analyzed: Neck Disability Index (NDI), visual analog scale-Neck, visual analog scale-Arm, and PROMIS Physical Function (PROMIS-PF) Computer Adaptive Test Score. Demographic, operative, and radiographic variables, and achievement of minimum clinically important difference (MCID) for each PRO were compared between the 2 groups. RESULTS A total of 66 patients were included in the present study, of which 35 (53%) were treated with CDR and 31 (47%) with ACDF. The preoperative cervical spondylotic grade was similar between the 2 groups (1.8 vs. 2.2, P=0.27). At final follow-up, there was no significant difference in the absolute value for each PRO between the 2 groups (P>0.19) and both groups demonstrated significant improvement in each PRO compared with preoperative values (P<0.01). There was no significant difference in the percentage of patients achieving the MCID for each PRO when comparing CDR to ACDF (P>0.09). CONCLUSIONS A similar percentage of patients with significant degenerative cervical spondylosis achieved the MCID across multiple PROs when treated with CDR or ACDF. Patients in both treatment groups demonstrated significant improvement in all PROs assessed when compared with preoperative values. LEVEL OF EVIDENCE Level III.
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Boehm BA, Njoku I, Furey CG. Single-Site Retrospective Assessment of Surgical Outcomes in Non-Ambulatory Patients with Degenerative Cervical Myelopathy. Spine (Phila Pa 1976) 2022; 47:331-336. [PMID: 34341319 DOI: 10.1097/brs.0000000000004185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study of surgical outcomes in patients with degenerative cervical myelopathy (DCM). OBJECTIVE To better characterize outcomes following cervical decompression in those with severe, non-ambulatory forms of DCM. SUMMARY OF BACKGROUND DATA DCM represents a collection of age-related degenerative processes of the cervical spine that can result in motor, sensory, and autonomic dysfunction, leading to significant reductions in quality of life. Individuals with severe, non-ambulatory forms of DCM are often treated with spinal decompression although the extent of neurological improvement for this patient population is unclear. METHODS A retrospective analysis of 48 non-consecutive non-ambulatory patients who underwent cervical decompression surgery between January 2007 and December 2018. Paired t tests and Wilcoxon signed rank tests were used to compare Nurick grade and modified Japanese Orthopedic Association (mJOA) score before and after surgery. Patient demographics, operative details, and postsurgical complications were analyzed using descriptive statistics. RESULTS Patients experienced significant improvements in both Nurick grade and mJOA score following cervical decompression surgery. The mean Nurick grade improved from 4.10 ± 0.31 to 2.21 ± 0.82 (P < 0.001, paired t test; 95% confidence interval [CI] -2.08 to -1.71), while the mean mJOA score improved from 10.58 ± 1.51 to 13.60 ± 1.58 (P < 0.001, paired t test; 95% CI 2.59-3.45). The average follow-up duration was 2.50 ± 1.83 years. Following surgery, 44 of the 48 patients in the study gained the ability to ambulate without the aid of a walking frame or someone else's assistance. CONCLUSION This study demonstrated that patients with severe forms of DCM experienced significant improvement in neurological function following cervical decompression surgery. These improvements indicate that cervical decompression surgery is effective in this patient population and has the potential to improve neurological status.Level of Evidence: 3.
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Affiliation(s)
- Blake A Boehm
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Innocent Njoku
- University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Christopher G Furey
- Case Western Reserve University School of Medicine, Cleveland, OH
- University Hospitals Cleveland Medical Center, Cleveland, OH
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Li B, Liu S, Wang Y, Zhao J, Song Y, Xu W, Zhang C, Gao C, Zhao Q, Wu D. The influence of carotid atherosclerosis on surgical outcomes of patients with cervical spondylotic myelopathy: A retrospective study. Medicine (Baltimore) 2022; 101:e28743. [PMID: 35119027 PMCID: PMC8812591 DOI: 10.1097/md.0000000000028743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/12/2022] [Indexed: 01/04/2023] Open
Abstract
The appearance of atherosclerosis in the carotid artery may be suggest the possibility of atherosclerosis in the spinal cord artery, which can cause spinal cord ischemia and further lead to neural element damage.According to the inclusion and exclude standard, there are 137 patients with cervical spondylotic myelopathy (CSM) incorporating retrospective analysis. These patients were consecutively admitted into The Second Hospital- Cheeloo College of Medicine-Shandong University from January 2016 to December 2018 and have accepted surgical treatment. All patients were examined by color Doppler ultrasound to detect carotid atherosclerosis before surgery. All patients were divided into 2 groups according to the presence or absence of carotid atherosclerosis: carotid atherosclerosis group (n = 88) and noncarotid atherosclerosis group (n = 49). All patients were followed up for at least 12 months after surgery. Demographic and surgery-related data were collected and analyzed to identify potential factors that affect the surgical outcomes in CSM.The average age of carotid atherosclerosis group (51 males and 37 females), and noncarotid atherosclerosis group (24 males and 25 females) were 62.02 ± 10.34 years (range, 38-85 years) and 49.61 ± 10.28 years (range, 26-67 years), respectively.In carotid atherosclerosis group: pre and postoperative modify Japanese Orthopedic Association Scores (mJOA score) were 11.58 ± 1.82 and 14.36 ± 1.64; the recovery rate of mJOA score was 45.57% ± 13.28%. In noncarotid atherosclerosis group: pre and postoperative mJOA score were 12.00 ± 2.11 and 15.04 ± 1.70; the recovery rate of mJOA score was 53.90% ± 13.22%. Univariate logistic regression analysis demonstrated that gender (P = .004), age ≥65 years (P = .001), duration of symptoms ≥12 months (P = .040), smoking history (P < .001), preoperative mJOA score ≤11 (P = .007) and carotid atherosclerosis (P = .004) were related to poor surgical outcomes. Multivariate logistic regression analysis showed significant correlations between poor surgical outcomes and age ≥65 years (P = .047), smoking history (P = .010), preoperative mJOA score ≤11 (P = .008) or carotid atherosclerosis (P = .047).Carotid atherosclerosis may be a risk factor for poor surgical outcomes in CSM.
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Affiliation(s)
- Bohan Li
- Health Management Center, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Shuling Liu
- Department of Radiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Shandong, PR China
| | - Yongmei Wang
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University,Shandong, PR China
| | - Jie Zhao
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Yang Song
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Wen Xu
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Cheng Zhang
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Chunzheng Gao
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Qian Zhao
- Department of cardiovascular, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
| | - Dongjin Wu
- Department of Spine Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Shandong, PR China
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Gharooni AA, Kwon BK, Fehlings MG, Boerger TF, Rodrigues-Pinto R, Koljonen PA, Kurpad SN, Harrop JS, Aarabi B, Rahimi-Movaghar V, Wilson JR, Davies BM, Kotter MRN, Guest JD. Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology. Global Spine J 2022; 12:109S-121S. [PMID: 35174725 PMCID: PMC8859698 DOI: 10.1177/21925682211052920] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' METHODS A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. RESULTS Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. CONCLUSION There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.
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Affiliation(s)
- Aref-Ali Gharooni
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin M. Davies
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mark R. N. Kotter
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
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The Correlation between Functional Connectivity of the Primary Somatosensory Cortex and Cervical Spinal Cord Microstructural Injury in Patients with Cervical Spondylotic Myelopathy. DISEASE MARKERS 2022; 2022:2623179. [PMID: 35096201 PMCID: PMC8791726 DOI: 10.1155/2022/2623179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022]
Abstract
Objectives To explore functional connectivity reorganization of the primary somatosensory cortex, the chronic microstructure damage of the cervical spinal cord, and their relationship in cervical spondylotic myelopathy (CSM) patients. Methods Thirty-three patients with CSM and 23 healthy controls (HCs) were recruited for rs-fMRI and cervical spinal cord diffusion tensor imaging (DTI) scans. Six subregions (including leg, back, chest, hand, finger and face) of bilateral primary somatosensory cortex (S1) were selected for seed-based whole-brain functional connectivity (FC). Then, we calculated the apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values of the cervical spinal cord. Correlation analysis was conducted between FC values of brain regions and DTI parameters of cervical spinal cord (ADC, FA), and their relationship with each other and clinical parameters. Results Compared with the HC group, the CSM group showed decreased FC between areas of the left S1hand, the left S1leg, the right S1chest, and the right S1leg with brain regions. The mean FA values of the cervical spinal cord in CSM patients were positively correlated with JOA scores. Especially, the FApos values of bilateral posterior funiculus were positively correlated with JOA scores. The ADC and FA values of bilateral posterior funiculus in the cervical spinal cord were also positively correlated with the FC values. Conclusions There was synchronization between chronic cervical spinal cord microstructural injury and cerebral cortex sensory function compensatory recombination. DTI parameters of the posterior cervical spinal cord could objectively reflect the degree of cerebral cortex sensory function impairment to a certain extent.
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Prospective Randomized Control Pilot Study to Compare the Role of Injection Cerebrolysin in Operated cases of Degenerative Cervical Myelopathy. Spine (Phila Pa 1976) 2022; 47:E58-E63. [PMID: 34889883 DOI: 10.1097/brs.0000000000004131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective randomized control trial. OBJECTIVE The aim of this study was to analyze role of cerebrolysin in patients of degenerative cervical myelopathy (DCM) managed by surgical modalities. SUMMARY OF BACKGROUND DATA Cerebrolysin has been extensively researched with variable success in neurodegenerative pathologies. There has been only one study in published literature till date that has studied role of cerebrolysin in DCM in conservatively managed patients but none in the patients treated surgically. We present our pilot study which analyzes the role of cerebrolysin in patients of DCM managed by surgical modalities. METHODS This prospective randomized control trial was conducted at a tertiary care institute in Mumbai. Sixty operated cases of DCM were randomly divided into 2 groups. The first group was given Injection Cerebrolysin 5 mL diluted in 100 mL Normal Saline over 30 minutes once a day for 21 days postoperatively. The second group was given placebo. Modified Japanese Orthopedic Association scores (mJOA) and visual analog scale (VAS) were used to document functional outcomes at 3 weeks, 3 months, 6 months, and 1 year. Recovery of hand function was separately accessed by improvement in hand power and sensations. RESULTS Preoperative mJOA and VAS scores were comparable between 2 groups. Both groups showed significant improvement in both mJOA and VAS scores at 3weeks, 3 months, 6 months and 1-year follow-up (P < 0.01). In comparing the two groups, there was no difference in improvement of mJOA and VAS scores. However, cerebrolysin group showed significant improvement in hand function at 1 year compared to the placebo. Postoperative neurological recovery was better in the cerebrolysin group with 66.7% patients showing complete neurological recovery compared to 56.7% for placebo, but this was statistically insignificant. Two patients developed headache and one patient complained of dizziness in the cerebrolysin group, but these resolved without any intervention. CONCLUSION Use of cerebrolysin in postoperative cases of DCM is safe and results in improved hand function.Level of Evidence: 1.
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Abstract
STUDY DESIGN A bibliometric review of the literature. OBJECTIVES The aim of this study was to identify the most highly cited articles relating to cervical myelopathy and to analyze the most influential articles. SUMMARY OF BACKGROUND DATA Over the past several decades, a lot of research has been conducted regarding the subject of cervical myelopathy. Although there are a large number of articles on this topic, to our knowledge, this is the first bibliometric analysis. METHODS A selection of search terms and keywords were inputted into the "Dimensions" database and the most highly cited articles in cervical myelopathy were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. RESULTS The 100 most cited articles in the topic of cervical myelopathy were published from 1956 to 2015. These articles, their corresponding authors, and number of citations are shown in Table 1. The number of citations ranged from 121 times for the 100th article to 541 times for the top article in a total of 20 journals. The most common topic was operative technique, whereas the journals which contributed the most articles were the Spine journal and the Journal of Neurosurgery. CONCLUSION Our study provided an extensive list of the most historically significant articles regarding cervical myelopathy, acknowledging the key contributions made to the advancement of this field.Level of Evidence: 5.
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Abstract
Degenerative cervical myelopathy (DCM) is a recently coined term encompassing a variety of age-related and genetically associated pathologies, including cervical spondylotic myelopathy, degenerative disc disease, and ligamentous aberrations such as ossification of the posterior longitudinal ligament. All of these pathologies produce chronic compression of the spinal cord causing a clinical syndrome characterized by decreased hand dexterity, gait imbalance, and potential genitourinary or sensorimotor disturbances. Substantial variability in the underlying etiology of DCM and its natural history has generated heterogeneity in practice patterns. Ongoing debates in DCM management most commonly center around clinical decision-making, timing of intervention, and the ideal surgical approach. Pivotal basic science studies during the past two decades have deepened our understanding of the pathophysiologic mechanisms surrounding DCM. Growing knowledge of the key pathophysiologic processes will help us tailor personalized approaches in an increasingly heterogeneous patient population. This article focuses on summarizing the most exciting approaches in personalizing DCM patient treatments including biomarkers, factors affecting clinical decision-making, and choice of the optimal surgical approach. Throughout we provide a concise review on the conditions encompassing DCM and discuss the underlying pathophysiology of chronic spinal cord compression. We also provide an overview on clinical-radiologic diagnostic modalities as well as operative and nonoperative treatment strategies, thereby addressing knowledge gaps and controversies in the field of DCM.
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Lan Z, Wu Z, Huang Y, Xu W. Increased Neck Tilt/T1 slope ratio may play an important role in patients with cervical kyphosis. BMC Musculoskelet Disord 2021; 22:785. [PMID: 34511094 PMCID: PMC8436478 DOI: 10.1186/s12891-021-04678-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background In previous studies, we demonstrated that the T1 slope (T1s) is associated with clinical outcomes, but the results were not specific for individuals. A recent study suggested that an increased pelvic tilt (PT)/sacral slope (SS) ratio may play an important role in the degeneration of lumbar scoliosis and pathogenesis of lumbar spondylolisthesis. Therefore, we aimed to explore the role of neck tilt (NT)/T1s in patients with cervical kyphosis. Methods In total, the data of 36 kyphosis patients who underwent anterior cervical hybrid decompression and fusion (ACHDF) for multilevel (3 levels) cervical spondylotic myelopathy were retrospectively analyzed. The radiographic measurements included the T1s, NT, C2–7 Cobb angle, and C2–7 sagittal vertical axis (SVA). The visual analog scale (VAS) and neck disability index (NDI) scores were used to determine the clinical prognosis. Pearson’s correlation coefficient was calculated to assess the relationships among preoperative imaging examination parameters. Results The mean C2–7 Cobb angle was − 5.93 ± 3.00° before surgery, 9.67 ± 6.61° after surgery, and 7.91 ± 8.73° at the follow-up. The preoperative NT/T1s ratio was positively correlated with the ΔC2–7 Cobb angle (r = 0.358, p < 0.05) and negatively correlated with the preoperative C2–7 Cobb angle (r = -0.515, p < 0.01) and preoperative C2–7 SVA (r = -0.461, p < 0.01). The linear regression model indicated a positive correlation between the preoperative NT/T1s ratio and the ΔC2–7 Cobb angle (R2 = 0.122). Conclusions The preoperative NT/T1s ratio may be positively correlated with changes in postoperative cervical spine curvature (Cobb angle). The NT/T1s ratio may be worthy of increased attention among sagittal parameters.
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Affiliation(s)
- Zhibin Lan
- The Spine Surgery Department, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Citong Road, Fengze District, 362000, Quanzhou, China
| | - Zhiqiang Wu
- The Spine Surgery Department, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Citong Road, Fengze District, 362000, Quanzhou, China
| | - Yuming Huang
- Department of Spine Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Weihong Xu
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, 350004, Fuzhou, Fujian, China.
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Ibrahim S, Mousa A, Riawan W. Expression of AIF and Caspase-3 in New Zealand rabbit with Cervical Spondylosis Myelopathy model. Ann Med Surg (Lond) 2021; 69:102604. [PMID: 34429943 PMCID: PMC8368771 DOI: 10.1016/j.amsu.2021.102604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Cervical spondylosis myelopathy (CSM) is a clinical syndrome of motoric or sensoric, caused by degenerative process chronically causing narrowing of cervical canal and compressing the spinal cord. The narrowing of canalis spinalis causing chronic compression and disrupting vascular patency in spinal cord. This is worsened on repetitive trauma on flexion, extension and rotation. CSM has an incidence of 4.04 in 100.000 cases per year and the total patients undergoing treatment operative or nonoperatively in year increasing for 7 times. Apoptosis plays a critical role in important biological processes such as morphogenesis, tissue homeostasis, and immunity; furthermore, its aberrant activation or impairment may contribute to a number of diseases. The understanding of CSM pathophysiology from apoptotic pathway is an essential topic to discussed and the treatment of this case in future. Method This study uses experimental study with Post test Only Control Group, using New Zealand rabbits. The rabbits given the compression on cervical as high as C5 to induce CSM. The tissue was taken from spinal cord on compression area and histopathology examination was done to calculate apoptotic factor expression such as AIF and caspase-3. Result Chronic compression on spinal cord causing myelopathy clinically on animal study, resulted in weakness of all extremities. Based on this study, the expression of AIF and caspase-3 is increasing in compression group in day 14 to day 21. Conclusion Chronic compression in spinal cord causing increase in AIF and caspase-3 in day 14 and day 21, and this may be caused by increasing of apoptotic expression on animal study.
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Affiliation(s)
- Sabri Ibrahim
- Department of Neurosurgery, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Abdurrahman Mousa
- Department of Neurosurgery, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Wibi Riawan
- Department of Biochemistry and Pathology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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Biomechanical Analysis of Posterior Ligaments of Cervical Spine and Laminoplasty. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11167645] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cervical laminoplasty is a valuable procedure for myelopathy but it is associated with complications such as increased kyphosis. The effect of ligament damage during cervical laminoplasty on biomechanics is not well understood. We developed the C2–C7 cervical spine finite element model and simulated C3–C6 double-door laminoplasty. Three models were created (a) intact, (b) laminoplasty-pre (model assuming that the ligamentum flavum (LF) between C3–C6 was preserved during surgery), and (c) laminoplasty-res (model assuming that the LF between C3–C6 was resected during surgery). The models were subjected to physiological loading, and the range of motion (ROM), intervertebral nucleus stress, and facet contact forces were analyzed under flexion/extension, lateral bending, and axial rotation. The maximum change in ROM was observed under flexion motion. Under flexion, ROM in the laminoplasty-pre model increased by 100.2%, 111.8%, and 98.6% compared to the intact model at C3–C4, C4–C5, and C5–C6, respectively. The ROM in laminoplasty-res further increased by 105.2%, 116.8%, and 101.8% compared to the intact model at C3–C4, C4–C5, and C5–C6, respectively. The maximum stress in the annulus/nucleus was observed under left bending at the C4–C5 segment where an increase of 139.5% and 229.6% compared to the intact model was observed for laminoplasty-pre and laminoplasty-res model, respectively. The highest facet contact forces were observed at C4–C5 under axial rotation, where an increase of 500.7% and 500.7% was observed compared to the intact model for laminoplasty-pre and laminoplasty-res, respectively. The posterior ligaments of the cervical spine play a vital role in restoring/stabilizing the cervical spine. When laminoplasty is performed, the surgeon needs to be careful not to injure the posterior soft tissue, including ligaments such as LF.
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Degenerative Cervical Myelopathy: Clinical Presentation, Assessment, and Natural History. J Clin Med 2021; 10:jcm10163626. [PMID: 34441921 PMCID: PMC8396963 DOI: 10.3390/jcm10163626] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/05/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of spinal cord injury and a major contributor to morbidity resulting from narrowing of the spinal canal due to osteoarthritic changes. This narrowing produces chronic spinal cord compression and neurologic disability with a variety of symptoms ranging from mild numbness in the upper extremities to quadriparesis and incontinence. Clinicians from all specialties should be familiar with the early signs and symptoms of this prevalent condition to prevent gradual neurologic compromise through surgical consultation, where appropriate. The purpose of this review is to familiarize medical practitioners with the pathophysiology, common presentations, diagnosis, and management (conservative and surgical) for DCM to develop informed discussions with patients and recognize those in need of early surgical referral to prevent severe neurologic deterioration.
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Valošek J, Labounek R, Horák T, Horáková M, Bednařík P, Keřkovský M, Kočica J, Rohan T, Lenglet C, Cohen-Adad J, Hluštík P, Vlčková E, Kadaňka Z, Bednařík J, Svatkova A. Diffusion magnetic resonance imaging reveals tract-specific microstructural correlates of electrophysiological impairments in non-myelopathic and myelopathic spinal cord compression. Eur J Neurol 2021; 28:3784-3797. [PMID: 34288268 PMCID: PMC8530898 DOI: 10.1111/ene.15027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Non-myelopathic degenerative cervical spinal cord compression (NMDC) frequently occurs throughout aging and may progress to potentially irreversible degenerative cervical myelopathy (DCM). Whereas standard clinical magnetic resonance imaging (MRI) and electrophysiological measures assess compression severity and neurological dysfunction, respectively, underlying microstructural deficits still have to be established in NMDC and DCM patients. The study aims to establish tract-specific diffusion MRI markers of electrophysiological deficits to predict the progression of asymptomatic NMDC to symptomatic DCM. METHODS High-resolution 3 T diffusion MRI was acquired for 103 NMDC and 21 DCM patients compared to 60 healthy controls to reveal diffusion alterations and relationships between tract-specific diffusion metrics and corresponding electrophysiological measures and compression severity. Relationship between the degree of DCM disability, assessed by the modified Japanese Orthopaedic Association scale, and tract-specific microstructural changes in DCM patients was also explored. RESULTS The study identified diffusion-derived abnormalities in the gray matter, dorsal and lateral tracts congruent with trans-synaptic degeneration and demyelination in chronic degenerative spinal cord compression with more profound alterations in DCM than NMDC. Diffusion metrics were affected in the C3-6 area as well as above the compression level at C3 with more profound rostral deficits in DCM than NMDC. Alterations in lateral motor and dorsal sensory tracts correlated with motor and sensory evoked potentials, respectively, whereas electromyography outcomes corresponded with gray matter microstructure. DCM disability corresponded with microstructure alteration in lateral columns. CONCLUSIONS Outcomes imply the necessity of high-resolution tract-specific diffusion MRI for monitoring degenerative spinal pathology in longitudinal studies.
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Affiliation(s)
- Jan Valošek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Department of Biomedical Engineering, University Hospital, Olomouc, Czechia
| | - René Labounek
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia.,Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tomáš Horák
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Magda Horáková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,High Field MR Centre, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Miloš Keřkovský
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Jan Kočica
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Tomáš Rohan
- Faculty of Medicine, Masaryk University, Brno, Czechia.,Department of Radiology and Nuclear Medicine, University Hospital Brno, Brno, Czechia
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, Quebec, Canada.,Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Quebec, Canada.,Mila - Quebec AI Institute, Montreal, Quebec, Canada
| | - Petr Hluštík
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - Eva Vlčková
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Zdeněk Kadaňka
- Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Josef Bednařík
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Neurology, University Hospital Brno, Brno, Czechia.,Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Alena Svatkova
- Central European Institute of Technology, Masaryk University, Brno, Czechia.,Department of Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria
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Wadhwa H, Sharma J, Varshneya K, Fatemi P, Nathan J, Medress ZA, Stienen MN, Ratliff JK, Veeravagu A. Anterior Cervical Discectomy and Fusion Versus Laminoplasty for Multilevel Cervical Spondylotic Myelopathy: A National Administrative Database Analysis. World Neurosurg 2021; 152:e738-e744. [PMID: 34153482 DOI: 10.1016/j.wneu.2021.06.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. METHODS We queried the MarketScan Commercial Claims and Encounters database to identify patients who had undergone ACDF or laminoplasty for multilevel CSM from 2007 to 2016. The patients were stratified by operation type. Patients aged <18 years, patients with a history of tumor or trauma, and patients who had undergone anteroposterior approach were excluded from the present study. RESULTS A total of 5445 patients were included, of whom 1521 had undergone laminoplasty. A matched cohort who had undergone ACDF was identified. The overall 90-day postoperative complication rate was greater in the laminoplasty cohort (odds ratio, 1.48; 95% confidence interval, 1.18-1.86; P < 0.0001). The mean length of stay and 90-day readmission rates were greater in the laminoplasty cohort. The hospital and total payments of the index hospitalization were greater in the ACDF cohort, as were the total payments for ≤2 years after the index hospitalization. CONCLUSIONS In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.
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Affiliation(s)
- Harsh Wadhwa
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jigyasa Sharma
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Kunal Varshneya
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Parastou Fatemi
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Jay Nathan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Zachary A Medress
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Martin N Stienen
- Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - John K Ratliff
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University Medical Center, Stanford, California, USA.
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