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Lee Y, Kim SY, Kim K. A Dynamic Magnetic Resonance Imaging Study of Changes in Severity of Cervical Spinal Stenosis in Flexion and Extension. Ann Rehabil Med 2018; 42:584-590. [PMID: 30180528 PMCID: PMC6129716 DOI: 10.5535/arm.2018.42.4.584] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/28/2017] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate changes in the severity of cervical spinal stenosis (CSS) in flexion and extension and determine whether the rate of change with motion varied with severity. Methods The study included 92 symptomatic patients with a mean age of 57.80±10.41, who underwent cervical spine dynamic magnetic resonance imaging. The severity of stenosis was evaluated using a semi-quantitative CSS score, ranging from 0 (no spinal stenosis) to 18 (severe stenosis). Radiological evaluation included flexion, neutral, and extension measurements, as determined by the C2–C7 Cobb angle. The severity of stenosis was represented by the total CSS score. The total CSS score in flexion, neutral, and extension positions was compared using repeated measures one-way analysis of variance. The change rate of stenosis per angle motion (CRSPAM) was defined as change in total CSS score divided by change in Cobb angle. The correlation of CRSPAM with severity of stenosis, represented by total CSS score in neutral position, was evaluated using Pearson correlation analysis. Results The total CSS score was significantly higher in extension (6.04±2.68) than in neutral position (5.25±2.47) (p<0.001), and significantly higher in neutral than in flexion position (4.40±2.45) (p<0.001). The CRSPAM was significantly and positively correlated with total CSS score in neutral position in the flexion-extension range (r=0.22, p=0.04) and flexion-neutral range (r=0.27, p=0.01). Conclusion In symptomatic CSS patients, the radiological severity of stenosis increases with extension and decreases with flexion. In patients with CSS, the rate of variation in spinal stenosis increases with increased severity.
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Affiliation(s)
- Yookyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Yeun Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Zika J, Alexiou GA, Giannopoulos S, Kastanioudakis I, Kyritsis AP, Voulgaris S. Outcome factors in surgically treated patients for cervical spondylotic myelopathy. J Spinal Cord Med 2018; 43:206-210. [PMID: 30040606 PMCID: PMC7054977 DOI: 10.1080/10790268.2018.1500225] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context/Objective: To investigate prospectively preoperative parameters that might be related to the outcome of surgically treated patients for cervical spondylotic myelopathy (CSM).Design: Prospective study.Setting: Single Center in Ioannina, Greece.Participants: Thirty-six patients were included in the study. There were 21 males and 15 females, mean age 50.8 years, range 39-70 years. The mean BMI was 27.3.Outcome measures: From each patient, we recorded age, sex, BMI, symptoms, duration of symptoms, comorbidities, lifestyle, myelopathy grade based on MRI and levels of compression. All patients completed the modified JOA (mJOA) and NPE questionnaires preoperatively and at 1, 3, 12 months and 5-years postoperatively.Results: The mean mJOA score significant improved from 10.8 ± 1.9 points preoperatively to 16.6 ± 2.2 points at 12 months postoperatively. The mean mJOA score at 5-years postoperatively was 15.5 ± 3 points. The difference was still highly significant. The mean NPE score significant improved from 59.8 ± 12.2 points preoperatively to 28.2 ± 8.5 points at 1 month, to 35.8 ± 8.1 points at 3 month and to 28.2 ± 8.8 points at 12 months postoperatively. Younger patients had significant higher baseline mJOA scores and significant higher mJOA scores 5-year postoperatively. No correlation was found between sex, BMI, symptom duration, baseline mJOA or myelopathy grade and outcome at 12 months or 5-year postoperatively.Conclusion: Age was highly predictive factor of outcome for patients undergoing surgical treatment of CSM.
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Affiliation(s)
- Jiolanda Zika
- Department of Rehabilitation Medicine, University Hospital of Ioannina, Ioannina, Greece
| | - George A. Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece,Correspondence to: George A. Alexiou, Department of Neurosurgery, University Hospital of Ioannina, PO BOX 103, Neohoropoulo, Ioannina 45500, Greece; Ph: +30 6948525134. ;
| | | | - Ioannis Kastanioudakis
- Department of Otolaryngology Head and Neck Surgery, University Hospital of Ioannina, Ioannina, Greece
| | | | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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Chin KR, Pencle FJ, Valdivia JM, Seale JA, Gabriel JP. Limiting fusion levels by combining anterior cervical decompression and fusion with posterior laminectomy: Technical note. J Orthop 2018; 15:412-415. [PMID: 29881166 PMCID: PMC5990210 DOI: 10.1016/j.jor.2018.03.019] [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: 12/27/2017] [Accepted: 03/19/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Authors aim to report on the outcomes of combining selective anterior cervical decompression and fusion (ACDF) with laminectomy in patients with cervical spondylotic radiculomyelopathy (CSR). METHODS 10 patients with ACDF and posterior laminectomy reviewed. RESULTS 60% female population, mean age 61 ± 3 years, mean BMI 24.7 ± 3.4 kg/m2. VAS and NDI showed significant improvement, p < 0.001, p = 0.02 respectively. Mean PCS 31.9 ± 2.7, MCS 38.9 ± 3.4 improved to mean PCS 42.2 ± 5.1, MCS 51.0 ± 4.7, p = 0.09 and 0.06 respectively. At final follow up fusion rate was 90% and all patients had Nurick Grade 0. CONCLUSION In this pilot study, procedure shown to be safe with improved symptoms.
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Affiliation(s)
- Kingsley R. Chin
- Herbert Wertheim College of Medicine at Florida International University
- Charles E. Schmidt College of Medicine at Florida Atlantic University
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
- Univerity of Technology, Jamaica, WI
| | - Fabio J.R. Pencle
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
| | - Juan M. Valdivia
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- BayCare Medical Group, 2727 West Dr. Martin Luther King Jr. Blvd. Suite 460, Tampa, FL 33607
| | - Jason A. Seale
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Less Exposure Surgical Specialists Institute (LESS Institute), 3816 Hollywood Blvd. Ste #102, Hollywood, FL 33021
| | - Josue P. Gabriel
- Less Exposure Surgery (LES) Society, 350 Main St., Malden, MA 02148
- Spine Institute of Ohio, 3535 Fishinger Blvd, Suite 280, Hilliard, OH 43026
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Vonck CE, Tanenbaum JE, Smith GA, Benzel EC, Mroz TE, Steinmetz MP. National Trends in Demographics and Outcomes Following Cervical Fusion for Cervical Spondylotic Myelopathy. Global Spine J 2018; 8:244-253. [PMID: 29796372 PMCID: PMC5958486 DOI: 10.1177/2192568217722562] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN Retrospective trends analysis. OBJECTIVES Cervical fusion is a common adjunctive surgical modality used in the treatment of cervical spondylotic myelopathy (CSM). The purpose of this study was to quantify national trends in patient demographics, hospital characteristics, and outcomes in the surgical management of CSM. METHODS This was a retrospective study that used the National Inpatient Sample. The sample included all patients over 18 years of age with a diagnosis of CSM who underwent cervical fusion from 2003 to 2013. The outcome measures were in-hospital mortality, length of stay, and hospital charges. Chi-square tests were performed to compare categorical variables. Independent t tests were performed to compare continuous variables. RESULTS We identified 62 970 patients with CSM who underwent cervical fusion from 2003 to 2013. The number of fusions performed per year in the treatment of CSM increased from 3879 to 8181. The average age of all fusion patients increased from 58.2 to 60.6 years (P < .001). Length of stay did not change significantly from a mean of 3.7 days. In-hospital mortality decreased from 0.6% to 0.3% (P < .01). Hospital charges increased from $49 445 to $92 040 (P < .001). CONCLUSIONS This study showed a dramatic increase in cervical fusions to treat CSM from 2003 to 2013 concomitant with increasing age of the patient population. Despite increases in average age and number of comorbidities, length of stay remained constant and a decrease in mortality was seen across the study period. However, hospital charges increased dramatically.
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Affiliation(s)
- Caroline E. Vonck
- Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Joseph E. Tanenbaum
- Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
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Gibson J, Nouri A, Krueger B, Lakomkin N, Nasser R, Gimbel D, Cheng J. Degenerative Cervical Myelopathy: A Clinical Review. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2018; 91:43-48. [PMID: 29599656 PMCID: PMC5872640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord impairment in adults and results in disability and reduced quality of life. DCM can present with a wide set of clinical and imaging findings, including: 1) pain and reduced range of motion of the neck, and motor and sensory deficits on clinical exam, and 2) cord compression due to static and dynamic injury mechanisms resulting from degenerative changes of the bone, ligaments, and intervertebral discs on MRI. The incidence and prevalence of DCM has been estimated at a minimum of 4.1 and 60.5 per 100,000, respectively, but surgical trends and an aging population suggest these numbers will rise in the future. The diagnosis of DCM is based on clinical examination, with a positive Hoffmann's sign and hand numbness typically appearing in the upper limbs, and gait abnormalities such as difficulty with tandem gait serving as sensitive diagnostic findings. Loss of bladder function may also occur in patients with severe DCM. The degree of neurological impairment can be measured using the modified Japanese Association Scale (mJOA) or Nurick grade. Non-operative management has a limited role in the treatment, while surgical management has been shown to both be safe and effective for halting disease progression and improving neurological function. Predictors of surgical outcome include age and baseline severity, indicating that early recognition of DCM is important for ensuring an optimal surgical outcome.
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Affiliation(s)
- Justin Gibson
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Aria Nouri
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH,Department of Neurosurgery, Yale University School of Medicine, New Haven, CT
| | - Bryan Krueger
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nikita Lakomkin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY
| | - Rani Nasser
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - David Gimbel
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph Cheng
- Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH,Department of Neurosurgery, Yale University School of Medicine, New Haven, CT,To whom all correspondence should be addressed: Joseph S. Cheng MD, MS, FAANS, FACS, Professor and Chairman, Department of Neurosurgery, Frank H. Mayfield Chair of Neurosurgery, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 2200 Cincinnati, Ohio, 45219
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Psychometric Validation of the Adapted Traditional Chinese (Hong Kong) Version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Spine (Phila Pa 1976) 2018; 43:E242-E249. [PMID: 28614280 DOI: 10.1097/brs.0000000000002287] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective questionnaire translation and validation. OBJECTIVE The aim of this study was to translate and cross-culturally adapt the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) into Traditional Chinese (Hong Kong) and to assess its validity, reliability, and sensitivity for differentiating cervical myelopathy (CM) and presence of acute neck/shoulder pain. SUMMARY OF BACKGROUND DATA CM frequently presents with various symptoms affecting patients' quality of life. Hence, a patient-oriented instrument such as JOACMEQ is necessary to assess patient-perceived outcomes of CM treatment. METHODS The English version of JOACMEQ was translated and adapted using double forward and single backward translations. The translated JOACMEQ was administered to patients with suspected CM, followed by the Traditional Chinese (Hong Kong) version of the Neck Disability Index (NDI), EuroQol five-dimension five-level (EQ-5D-5L), and Short Form-12 version 2 (SF-12v2) questionnaires. Construct validity of the domains was assessed using Spearman correlation test against domains with similar constructs. Internal consistency was assessed by Cronbach's alpha. Sensitivity of the adapted JOACMEQ was determined by known group comparisons. RESULTS A total of 100 patients were recruited. Psychometric testing of the translated JOACMEQ demonstrated an excellent overall internal consistency with Cronbach's α > 0.9, and good internal consistency of Lower Extremity Function (0.823) and Quality of Life (0.875) domains. Score of all domains of the translated JOACMEQ had significant correlations (P < 0.01-0.05) with nearly all domains of SF-12v2 and with both NDI and EQ-5D-5L scores. JOACMEQ was sensitive in detecting differences (P < 0.001) between subjects who had CM and those without, and also between those patients with/without CM experiencing current neck/shoulder pain. CONCLUSION Our translated JOACMEQ has satisfactory psychometric properties, including adequate clinical and construct validity, and internal consistency in patients with suspected/diagnosed CM and can differentiate between those with/without pain. It is demonstrated as a sensitive outcome measure for CM and neck/shoulder pain. LEVEL OF EVIDENCE 2.
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Wang KF, Duan S, Zhu ZQ, Liu HY, Liu CJ, Xu S. Clinical and Radiologic Features of 3 Reconstructive Procedures for the Surgical Management of Patients with Bilevel Cervical Degenerative Disc Disease at a Minimum Follow-Up Period of 5 Years: A Comparative Study. World Neurosurg 2018; 113:e70-e76. [PMID: 29408574 DOI: 10.1016/j.wneu.2018.01.157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/19/2018] [Accepted: 01/20/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the mid-long-term follow-up of the safety and efficacy of anterior cervical discectomy and fusion (ACDF), cervical artificial disc replacement (CADR) and hybrid surgery (HS) for bilevel cervical degenerative disc disease (cDDD). METHODS 77 patients who underwent ACDF, HS, and CADR were retrospectively reviewed. Clinical effects were evaluated based on Neck Disability Index (NDI), Visual Analog Scale (VAS), and Japanese Orthopedic Association (JOA) scores and the Odom criteria. Radiographic outcomes were evaluated, including cervical range of motion (ROM), ROM in the operative and adjacent segments, incidence of degeneration in the adjacent segments (ASD), and heterotopic ossification (HO). RESULTS NDI, VAS, and JOA scores significantly improved in all patients after surgery without significant differences between groups. The excellent-to-good ratio in the Odom scale was 28/30 for the HS group, 30/33 for the ACDF group, and 13/14 for the CADR group. No significant differences in clinical outcomes or complication were found between groups (P > 0.05). Furthermore, the HS and CADR groups had less decreased ROM in the cervical and operative segments and less compensatory ROM in adjacent segments (P < 0.05). By contrast, the ACDF group had decreased ROM in the cervical and operative segments and significantly increased ROM in adjacent segments (P < 0.05). Moreover, the incidence of ASD was higher in the ACDF group, but the difference was not statistically significant (P > 0.05). HO was found in 10 patients (33.3%) in the HS group and 5 patients (35.7%) in the CADR group. CONCLUSION HS was superior to ACDF with regard to equivalent clinical outcomes in the mid-long-term follow-up. Furthermore, HS was superior in the maintenance of ROM and had less impact on its adjacent segments. The efficacy of HS is similar to that of CADR.
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Affiliation(s)
- Kai-Feng Wang
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuo Duan
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Zhen-Qi Zhu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China.
| | - Hai-Ying Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Chen-Jun Liu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
| | - Shuai Xu
- Department of Spine Surgery, Peking University People's Hospital, Beijing, China
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Okazaki T, Kanchiku T, Nishida N, Ichihara K, Sakuramoto I, Ohgi J, Funaba M, Imajo Y, Suzuki H, Chen X, Taguchi T. Age-related changes of the spinal cord: A biomechanical study. Exp Ther Med 2018; 15:2824-2829. [PMID: 29599828 PMCID: PMC5867489 DOI: 10.3892/etm.2018.5796] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/19/2018] [Indexed: 11/26/2022] Open
Abstract
Although it is known that aging plays an important role in the incidence and progression of cervical spondylotic myelopathy (CSM), the underlying mechanism is unclear. Studies that used fresh bovine cervical spinal cord report the gray matter of the cervical spinal cord as being more rigid and fragile than the white matter. However, there are no reports regarding the association between aging an tensile and Finite Element Method (FEM). Therefore, FEM was used based on the data pertaining to the mechanical features of older bovine cervical spinal cord to explain the pathogenesis of CSM in elderly patients. Tensile tests were conducted for white and gray matter separately in young and old bovine cervical spinal cords, and compared with their respective mechanical features. Based on the data obtained, FEM analysis was further performed, which included static and dynamic factors to describe the internal stress distribution changes of the spinal cord. These results demonstrated that the mechanical strength of young bovine spinal cords is different from that of old bovine spinal cords. The gray matter of the older spinal cord was significantly softer and more resistant to rupture compared with that of younger spinal cords (P<0.05). Among the old, although the gray matter was more fragile than the white matter, it was similar to the white matter in terms of its rigidity (P<0.05). The in vitro data were subjected to three compression patterns. The FEM analysis demonstrated that the stress level rises higher in the old spinal cords in response to similar compression, when compared with young spinal cords. These results demonstrate that in analyzing the response of the spinal cord to compression, the age of patients is an important factor to be considered, in addition to the degree of compression, compression speed and parts of the spinal cord compression factor.
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Affiliation(s)
- Tomoya Okazaki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Tsukasa Kanchiku
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Kazuhiko Ichihara
- Non Profit Organization Corporation Japan Orthopedic Biomechanics Institute, Hofu, Yamaguchi 7470814, Japan
| | - Itsuo Sakuramoto
- Department of Mechanical and Electrical Engineering, Tokuyama College of Technology, Gakuendai, Shunan, Yamaguchi 7458585, Japan
| | - Junji Ohgi
- Department of Mechanical Engineering, Yamaguchi University, Ube, Yamaguchi 7558611, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Yasuaki Imajo
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
| | - Xian Chen
- Department of Mechanical Engineering, Yamaguchi University, Ube, Yamaguchi 7558611, Japan
| | - Toshihiko Taguchi
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 7558505, Japan
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Yamaguchi S, Mitsuhara T, Abiko M, Takeda M, Kurisu K. Epidemiology and Overview of the Clinical Spectrum of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:1-12. [DOI: 10.1016/j.nec.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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de A Bonelli M, da Costa RC. Comparison of the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy. Am J Vet Res 2017; 79:83-89. [PMID: 29287165 DOI: 10.2460/ajvr.79.1.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the percentage of the C3-C7 vertebral canal occupied by the spinal cord in small-breed dogs with that in Doberman Pinschers and Great Danes with and without cervical spondylomyelopathy (CSM). ANIMALS 30 small-breed dogs (body weight, < 15 kg), 15 clinically normal Doberman Pinschers, 15 Doberman Pinschers with CSM, 15 clinically normal Great Danes, and 15 Great Danes with CSM. PROCEDURES In a retrospective study, sagittal and transverse T2-weighted MRI images of the cervical (C3 to C7) vertebral column obtained from dogs that met study criteria and were free of extensive abnormalities that could affect the spinal cord diameter between January 2005 and February 2015 were reviewed. The area and height of the vertebral column and spinal cord were measured at the cranial and caudal aspect of each vertebra from C3 to C7, and the percentage of the vertebral canal occupied by the spinal cord at each location was calculated and compared among groups of dogs. RESULTS Mean percentage of the vertebral canal occupied by the spinal cord was greatest for small-breed dogs and lowest for Great Danes, but did not differ between Doberman Pinschers and small-breed dogs at approximately half of the locations evaluated or between Doberman Pinschers with and without CSM or between Great Danes with and without CSM. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the percentage of the vertebral canal occupied by the spinal cord, although expected to increase with vertebral canal stenosis, may not have a primary role in the pathogenesis of CSM.
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Ohta R, Shimabukuro A. Parsonage-Turner syndrome in a patient with bilateral shoulder pain: A case report. J Rural Med 2017; 12:135-138. [PMID: 29255532 PMCID: PMC5721299 DOI: 10.2185/jrm.2933] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/16/2017] [Indexed: 11/27/2022] Open
Abstract
Objective: Parsonage-Turner syndrome is a peripheral neuropathy
characterized by acute onset shoulder pain, myalgia, and sensory disturbances. The present
report discusses a rare case of Parsonage-Turner syndrome and highlights the importance of
accurate history recording and thorough physical examination for the diagnosis of the
disease in rural areas. Patient: A 28-year-old woman presented to our clinic with acute bilateral
shoulder pain and difficulty moving her right arm. A diagnosis of Parsonage-Turner
syndrome was suspected based on the progression of symptoms, severity of pain, and lack of
musculoskeletal inflammation. The diagnosis was confirmed by neurological specialists, and
the patient was treated with methylprednisolone, after which her symptoms gradually
improved. Discussion: The differential diagnosis of shoulder pain is complicated due
to the wide variety of conditions sharing similar symptoms. Accurate history recording and
thorough physical examination are required to differentiate among conditions involving the
central nerves, peripheral nerves, and nerve plexuses. Conclusion: Although the symptoms of Parsonage-Turner syndrome vary based on
disease progression and the location of impairment, proper diagnosis of acute shoulder
pain without central neurological symptoms can be achieved in rural areas via thorough
examination.
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Affiliation(s)
- Ryuichi Ohta
- Department of Community Care, Unnan City Hospital, Japan
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Abstract
Degenerative cervical myelopathy (DCM) is a common spinal cord disease caused by chronic mechanical compression of the spinal cord. The mechanism by which mechanical stress results in spinal cord injury is poorly understood. The most common mechanisms involved in the pathobiology of DCM include apoptosis, inflammation, and vascular changes leading to loss of neurons, axonal degeneration, and myelin changes. However, the exact pathophysiologic mechanisms of DCM are unclear. A better understanding of the pathogenesis of DCM is required for the development of treatments to improve outcomes. This review highlights the mechanisms of injury and pathology in DCM.
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Affiliation(s)
- Farhana Akter
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, University of Cambridge, West Forvie Building, Forvie Site Box 213, Hills Road, Cambridge CB2 0SZ, UK.
| | - Mark Kotter
- Department of Clinical Neurosciences, Ann McLaren Laboratory of Regenerative Medicine, University of Cambridge, West Forvie Building, Forvie Site Box 213, Hills Road, Cambridge CB2 0SZ, UK
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Patterns of Neurological Recovery After Anterior Decompression With Fusion and Posterior Decompression With Laminoplasty for the Treatment of Multilevel Cervical Spondylotic Myelopathy. Clin Spine Surg 2017; 30:E1104-E1110. [PMID: 27280783 DOI: 10.1097/bsd.0000000000000396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
STUDY DESIGN The pattern of neurological recovery in the overall modified Japanese Orthopedic Association scores, upper limb function score, and lower limb function score after surgical decompression for patients suffering from multilevel cervical spondylotic myelopathy (CSM) were analyzed in this independent retrospective study. OBJECTIVE The primary objective of this retrospective study was to compare the upper and lower limb function changes after anterior decompression with fusion versus posterior decompression with laminoplasty for patients suffering from multilevel CSM. An additional objective was to describe the neural recovery speed. SUMMARY OF BACKGROUND DATA Few comparative studies have been conducted to evaluate the outcome of anterior versus posterior surgery in multilevel CSM. However, these assessments tend to be of a more global perspective, looking at a composite score for upper limb, lower limb, and bladder function. No reports have separately analyzed the upper and lower limb function changes after anterior and posterior decompression for multilevel CSM. MATERIALS AND METHODS A total of 132 patients were classified into anterior and posterior decompression groups based on the different surgical approach they underwent. The pattern of neurological recovery in the overall modified Japanese Orthopedic Association scores, upper limb function score, and lower limb function score after surgical decompression were documented and analyzed. RESULTS There was no significant difference in the overall neurological recovery between anterior and posterior decompression groups. But in terms of the upper or lower limb function changes after operation, it appeared that the upper limbs recovered better with anterior decompression. The surgical approach did not significantly alter lower extremity recovery potential. In addition, most of the neurological recovery occurred in the first 9 months after surgical decompression. CONCLUSIONS We recommend a individualized approach when it is difficult to determine an anterior or posterior surgery for multilevel CSM. Rehabilitation training should be carried out as early as possible.
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Rehman L, Bokhari I, Afzal A, Ahmad S. Posterior occipito cervical decompression with fixation and fusion in Cranio vertebral junction compression. Pak J Med Sci 2017; 33:1194-1198. [PMID: 29142563 PMCID: PMC5673732 DOI: 10.12669/pjms.335.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 05/10/2017] [Accepted: 10/04/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To find out the clinical outcome of posterior decompression with occipitocervical fixation and fusion in patients with Craniovertebral junction instability. METHODS Eighty consecutive patients of cranio vertebral junction (CVJ) compression were treated in the department of neurosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi over a period of 05 years from 1st January 2012 till 31st August 2016. All patients underwent posterior decompression with occipitocervical fusion (OCF) and fixation. The clinical outcome was assessed by Japanese Orthopedic Association (JOA) score and grading. RESULTS Out of 80 patients with CVJ instability, 64 (80%) were due to non traumatic causes, while 16 (20%) were secondary to trauma. All 80 patients(100%) showed post operative relief in pain. Sixty four (80%) patients showed improvement in power post operatively while six (7.5%) had no change, four (5%) showed deterioration and six (7.5%) patients expired. Sixty four (80%) patients had improvement of the JOA scores at last follow-up. According to etiology, the JOA score for patients with trauma improved in 12(75%) patients and 52(81.25%) for non traumatic causes while six patients (7.5%) expired. Fusion was achieved in 64 (80%) patients at last follow-up. CONCLUSION Posterior decompression with occipitocervical fusion and fixation is safe and can be recommended in cases of CVJ compression.
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Affiliation(s)
- Lal Rehman
- Dr. Lal Rehman, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Iram Bokhari
- Dr. Iram Bokhari, FCPS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Ali Afzal
- Dr. Ali Afzal, MBBS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Shakeel Ahmad
- Dr. Shakeel Ahmed, MBBS. Department of Neurosurgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Abstract
Degenerative disease of the spine is a leading cause of back pain and radiculopathy, and is a frequent indication for spine MR imaging. Disc degeneration, disc protrusion/herniation, discarhtrosis, spinal canal stenosis, and facet joint arthrosis, as well as interspinous processes arthrosis, may require an MR imaging workup. This review presents the MR imaging patterns of these diseases and describes the benefit of the MR imaging in these indications compared with the other imaging modalities like plain radiographs or computed tomography scan.
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66
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Meng Z, Yu J, Luo C, Liu X, Jiang W, Yu L, Huang R. Anterior Cervical Spondylosis Surgical Interventions are Associated with Improved Lordosis and Neurological Outcomes at Latest Follow up: A Meta-analysis. Sci Rep 2017; 7:4407. [PMID: 28667278 PMCID: PMC5493671 DOI: 10.1038/s41598-017-04311-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/10/2017] [Indexed: 11/09/2022] Open
Abstract
Aim of this study was to evaluate the effect of cervical spondylosis surgery on cervical lordosis and to identify factors affecting the change by latest follow-up. Literature search was carried out in electronic databases and study selection followed a priori eligibility criteria. Random effects meta-analyses were performed to estimate effect size/s of change in lordosis after surgery (at latest follow-up) and metaregression analyses were performed to identify factors affecting this change. Nineteen studies (1845 patients; age 55.18 [95% CI: 54.78, 55.57] years; 60.99 [60.63, 61.36] % males; follow-up 25.59 [25.20, 25.99] months) were included. Whereas, corpectomy (4.06 [2.65, 5.46] degree; p < 0.00001) and discectomy (4.59 [2.07, 7.11] degree; p < 0.00001) were associated with increase, laminectomy (-1.87 [-8.40, 4.66] degree; p = 0.57) and laminoplasty (0.25 [-1.07, 1.56] degree; p = 0.711) were not associated with significant change in lordosis at latest follow-up. Change in Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score at latest follow-up was also significantly (p = 0.0005) higher in anterior than in posterior surgery group. Change in lordosis at latest follow-up had significant positive relationship with follow-up duration but had significant inverse associations with age, male gender, and preoperative JOA/mJOA score, independently. In posterior surgery subjects, after adjusting for age and gender, preoperative JOA/mJOA score was significantly inversely related to change in lordosis.
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Affiliation(s)
- Zengdong Meng
- Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P. R. China
| | - Jing Yu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, P. R. China
| | - Chong Luo
- Department of Orthopaedics, First People's Hospital of YunNan Province, YunNan, P. R. China
| | - Xia Liu
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, Shanghai, P.R. China
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Rongzhong Huang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China.
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Jutzeler CR, Ulrich A, Huber B, Rosner J, Kramer JL, Curt A. Improved Diagnosis of Cervical Spondylotic Myelopathy with Contact Heat Evoked Potentials. J Neurotrauma 2017; 34:2045-2053. [DOI: 10.1089/neu.2016.4891] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Anett Ulrich
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Barbara Huber
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
| | - John L.K. Kramer
- ICORD, University of British Columbia, Vancouver, British Columbia, Canada
| | - Armin Curt
- Spinal Cord Injury Center, University Hospital Balgrist, Zurich, Switzerland
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Passias PG, Marascalchi BJ, Boniello AJ, Yang S, Bianco K, Jalai CM, Worley NJ, Horn SR, Lafage V, Bendo JA. Cervical spondylotic myelopathy: National trends in the treatment and peri-operative outcomes over 10years. J Clin Neurosci 2017; 42:75-80. [PMID: 28476459 DOI: 10.1016/j.jocn.2017.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 04/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies show increases in cervical spine surgery prevalence and cervical spondylotic myelopathy (CSM) diagnoses in the US. However, few studies have examined outcomes for CSM surgical management, particularly on a nationwide scale. OBJECTIVE Evaluate national trends from 2001 to 2010 for CSM patient surgical approach, postoperative outcomes, and hospital characteristics. METHODS A retrospective nationwide database analysis provided by the Nationwide Inpatient Sample (NIS) including CSM patients aged 25+ who underwent anterior and/or posterior cervical fusion or laminoplasty from 2001 to 2010. Patients with fractures, 9+ levels fused, or any cancer were excluded. Measures included demographics, hospital data, and procedure-related complications. Yearly trends were analyzed using linear regression modeling. RESULTS 54,348 discharge cases were identified. ACDF, posterior only, and combined anterior/posterior approach volumes significantly increased from 2001 to 2010 (98.62%, 303.07%, and 576.19%; respectively, p<0.05). However, laminoplasty volume remained unchanged (p>0.05). Total charges for ACDF, posterior only, combined anterior/posterior, and laminoplasty approaches all significantly increased (138.72%, 176.74%, 182.48%, and 144.85%, respectively; p<0.05). For all procedures, overall mortality significantly decreased by 45.34% (p=0.001) and overall morbidity increased by 33.82% (p=0.0002). For all procedures except ACDF, which saw a significantly decrease by 8.75% (p<0.0001), length of hospital stay was unchanged. CONCLUSIONS For CSM patients between 2001 and 2010, combined surgical approach increased sixfold, posterior only approach increased threefold, and ACDF doubled; laminoplasties without fusion volume remained the same. Mortality decreased whereas morbidity and total charges increased. Length of stay decreased only for ACDF approach. This study provides clinically useful data to direct future research, improving patient outcomes.
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Affiliation(s)
- Peter G Passias
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States.
| | - Bryan J Marascalchi
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Anthony J Boniello
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Sun Yang
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Kristina Bianco
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Cyrus M Jalai
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Nancy J Worley
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Samantha R Horn
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
| | - Virginie Lafage
- Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, United States
| | - John A Bendo
- Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, United States
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Purvis TE, Lubelski D, Mroz TE. Is Decompressive Surgery for Cervical Spondylotic Myelopathy Effective in Patients Suffering from Concomitant Multiple Sclerosis or Parkinson's Disease? Brain Sci 2017; 7:brainsci7040039. [PMID: 28394266 PMCID: PMC5406696 DOI: 10.3390/brainsci7040039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/29/2017] [Accepted: 04/06/2017] [Indexed: 12/20/2022] Open
Abstract
A subset of patients with a demyelinating disease suffer from concurrent cervical spondylotic myelopathy, both of which evince similar symptomatology. Differentiating the cause of these symptoms is challenging, and little research has been done on patients with coexisting diseases. This review explores the current literature on the appropriate surgical management of patients with concurrent multiple sclerosis (MS) and cervical spondylotic myelopathy (CSM), and those with both Parkinson’s disease (PD) and CSM. MS and CSM patients may benefit from surgery to reduce pain and radiculopathy. Surgical management in PD and CSM patients has shown minimal quality-of-life improvement. Future studies are needed to better characterize demyelinating disease patients with concurrent disease and to determine ideal medical or surgical treatment.
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Affiliation(s)
- Taylor E Purvis
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, 9500 Euclid Ave, S-80, Cleveland, OH 44195, USA.
- Department of Neurological Surgery, Cleveland Clinic, 9500 Euclid Ave, S-40, Cleveland, OH 44195, USA.
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Abstract
STUDY DESIGN Retrospective multi-center study. OBJECTIVE This study was conducted to clarify the incidence and neurological outcomes of fall-related deterioration of subjective symptoms in patients undergoing surgical treatment. SUMMARY OF BACKGROUND DATA The evidence that minor trauma, including falls, increases the risk of worsening cervical myelopathy is insufficient. METHODS A retrospective analysis of patients who had undergone surgery for cervical myelopathy at 12 participating institutes was conducted. Patients who had undergone surgery for symptomatic cervical myelopathy from January 2012 to December 2013 and completed at least 1-year follow-up were included in this study. Data were collected by chart review and a questionnaire that included numbers of recalled falls during the last preoperative year and first postoperative year, circumstances of falls, and whether the patient had experienced fall-related deterioration of subjective symptoms. RESULTS A total of 360 eligible patients were recruited into the study. Of these, 177 (49%) reported at least one fall during the last preoperative year, and 105 (29%) experienced fall-related deterioration of subjective symptoms. Forty (11%) reported deterioration of numbness in the arms or legs, and 65 (18%) reported deterioration of motor deficits. Incidences of falls and fall-related deterioration of symptoms decreased significantly after surgery. Patients who experienced fall-related deterioration of motor deficits showed significantly worse surgical outcomes as assessed by Japanese Orthopaedic Association (JOA) score compared with those who did not experience deterioration. The optimal cut-off for preoperative JOA score in predicting an increased risk of fall-related deterioration in motor deficits was 8. CONCLUSION Patients with cervical myelopathy commonly experienced preoperative fall-related deterioration of subjective symptoms, associated with significantly worse neurological outcomes. Surgical treatment significantly reduced the incidence of both falls and fall-related deterioration of subjective symptoms. LEVEL OF EVIDENCE 4.
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UH MARVINJESUALDOVARGAS, MOGA AMADOGONZÁLEZ, BENITEZ HUGOSANTOS, HERNANDEZ GABRIELHUERTA, CARRANZA JUANENRIQUEGUZMÁN. FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY. COLUNA/COLUMNA 2017. [DOI: 10.1590/s1808-185120171602172279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To analyze the functional outcome of surgical treatment of cervical spondylotic myelopathy. Methods: A retrospective study involving 34 patients with CSM, operated from January 2014 to June 2015. The neurological status was assessed using the Nurick and modified Japanese Orthopedic Association (mJOA) scales preoperatively and at 12 months. Sex, age, time of evolution, affected cervical levels, surgical approach and T2-weighted magnetic resonance hyperintense signal were also evaluated. Results: A total of 14 men and 20 women participated. The mean age was 58.12 years. The average progression time was 12.38 months. The preoperative neurological state by mJOA was mild in 2 patients, moderate in 16 and severe in 16, with a mean of 11.44 points. The preoperative Nurick was grade II in 14 patients, grade III in 8, grade IV in 10 and grade V in 2. The T2-weighted hyperintense signal was documented in 18 patients (52.9%). The functional outcome according to the mJOA recovery rate was good in 15 patients (44.1%) and poor in 19 (55.9%). The degree of Nurick recovery was good in 20 (58.8%) and poor in 14 (41.2%). Conclusions: Decompressive surgery of the spinal cord has been shown to be effective in the treatment of cervical spondylotic myelopathy in well-selected patients. Although it is suggested that there are certain factors that correlate with functional outcome, we believe that more prospective randomized studies should be conducted to clarify this hypothesis.
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Singh SK, Rajoria K. Ayurvedic management in cervical spondylotic myelopathy. J Ayurveda Integr Med 2017; 8:49-53. [PMID: 28285113 PMCID: PMC5377481 DOI: 10.1016/j.jaim.2016.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/07/2022] Open
Abstract
The age related spondylotic changes may result in direct compressive and ischemic dysfunction of the spinal cord known as cervical spondylotic myelopathy (CSM). Symptoms often develop insidiously and are characterized by neck stiffness, unilateral or bilateral deep aching neck, arm and shoulder pain, and possibly stiffness or clumsiness while walking. The management available in current mainstream medicine is not satisfactory. Various Ayurvedic treatments have been in use for these manifestations. We present a case of CSM, which was treated with a combination of Panchakarma procedures and Ayurvedic oral drugs. The patient was considered suffering from Greevastambha (neck stiffness) and was treated with Shalishastika pinda svedana (sudation with medicated cooked bolus of rice) for one month and Mustadi yapana basti (enema with medicated milk) for 16 days along with oral Ayurvedic drugs such as Brihatavata chintamani rasa 50 mg, Ekangaveer ras-250 mg, Ardhangavatari rasa-125 mg Amrita satva (dry extract of Tinospora cordifolia Willd)-500 mg, Muktasukti pisti-500 mg, Ashwagandha churna (powder of Withania somnifera Dunal)-500 mg Dashmool kvatha ghana (solid extract of Dashmool kvatha)-500 mg, Trayodashanga guggulu-575 mg, twice a day with honey and Eranda paka-10 g twice a day with milk. Patient's condition which was assessed for symptoms of CSM and Chile's modified Japanese Orthopaedic Association (mJOA) score for cervical spondylotic myelopathy showed substantial improvement. This study shows that the cases of CSM may be successfully managed with Ayurvedic treatment.
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Affiliation(s)
- Sarvesh Kumar Singh
- P.G. Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.
| | - Kshipra Rajoria
- Department of Panchkarma, S.S.S.B. Ayurvedic College and Hospital, Renwal, Jaipur, Rajasthan, India
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73
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Smith-Robinson procedure with and without Caspar plating as a treatment for cervical spondylotic myelopathy: A 26-year follow-up of 23 patients. 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 2017; 26:1246-1253. [PMID: 28185064 DOI: 10.1007/s00586-017-4988-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/18/2017] [Accepted: 01/31/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to assess long-term follow-up data after anterior cervical decompression and fusion (ACDF) with and without Caspar plating (ACDF + PS) for the treatment of cervical spondylotic myelopathy (CSM) with special focus on functional outcome, pain, and repeat surgery for adjacent segment disease (ASD). METHOD Hospital records of 45 patients who were affected by CSM and underwent ACDF or ACDF + PS at least 17 years ago were reviewed. Information about diagnosis, surgical report, pre- and postoperative clinical process, and complications was analyzed. Clinical outcome was assessed using a standardized questionnaire including the Neck Disability Index (NDI), modified JOA-score, Odom's criteria, limitations in quality of life, and questions about the current neurological status and pain. RESULTS Twenty-three patients with a mean follow-up of 26 years were evaluated. ACDF was performed in nine and ACDF + PS in 14 patients, respectively. At follow-up 78.3% of patients were free of pain, 91.3% had no motor deficit, 73.9% had no sensory deficit, and 60.7% had no gait disturbance. The current mean NDI is 14% (range 2-44%), the mean modified JOA-score was 17.2 (range 15-18). According to Odom's criteria 78.3% of patients had clinical success. In four patients repeat surgery was indicated due to pseudarthrosis or symptomatic ASD (17.4%). CONCLUSIONS ACDF and ACDF + PS yield significant decrease in neck pain, a significant increase in sensorimotor function and a high rate of clinical success. Patients with preoperative gait disturbance completely recovered in about 60% of cases. Overall prevalence for ASD was 17.4% after 25 years.
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[Results to 4-year follow-up of the treatment of the cervical stenosis by corpectomy, titanium mesh cage and anterior plate fixation]. CIR CIR 2017; 85:381-386. [PMID: 28104281 DOI: 10.1016/j.circir.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 10/26/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cervical spondylotic myelopathy is caused by cervical stenosis. Several techniques have been described for the treatment of multilevel disease, such as the anterior corpectomy with titanium mesh cage and anterior cervical plate placement, which has the advantage of performing a wider decompression and using the same bone as graft. However, it has caused controversy since the collapse of the mesh cage continues being a major limitation of this procedure. MATERIAL AND METHOD A prospective 4-year follow-up study was conducted in 7 patients diagnosed with cervical stenosis, who were treated surgically by one level corpectomy with titanium mesh cage and anterior cervical plate placement, evaluating them by radiographs and clinical scales. RESULTS 7 patients, 5 women and 2 males were studied. The most common level was C5 corpectomy (n=4). The Neck Disability Index (NDI) preoperative average was 30.01±24.32 and 4-year postoperative 16.90±32.05, with p=0.801. The preoperative and 4-year postoperative Nürick was 3.28± 48 and 3.14±1.21 respectively, with p=0.766. Preoperative lordosis was 14.42±8.03 and 4-year postoperative 17±11.67 degrees, with p=0.660. The immediate postoperative and 4-year postoperative subsidence was 2.69±2.8 and 6.11±1.61 millimeters respectively, with p=0.0001. CONCLUSIONS Despite the small sample, the subsidence of the mesh cage is common in this procedure. No statistically significant changes were observed in the lordosis or Nürick scale and NDI.
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Niyogi S, Basak S, Acharjee A, Chakraborty I. Efficacy of intravenous dexmedetomidine on patient's satisfaction, comfort and sedation during awake fibre-optic intubation in patients with cervical spondylotic myelopathy posted for elective cervical fixation. Indian J Anaesth 2017; 61:137-143. [PMID: 28250482 PMCID: PMC5330070 DOI: 10.4103/0019-5049.199856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Aims: Various anaesthetic drugs, in addition to airway block, are used for producing favourable intubation conditions during awake fibre-optic intubation (AFOI), but most of them cause respiratory depression and hypoxaemia. The aim of this study was to evaluate the efficacy of intravenous (IV) dexmedetomidine (DEX) on sedation, patient comfort and cardiovascular responses during AFOI in patients with cervical spondylotic myelopathy (CSM). Methods: This randomised, placebo-controlled, double-blinded, prospective study was conducted on 56 adult patients with cervical spondylotic myelopathy (CSM) undergoing elective cervical fixation, who were randomly allocated into two groups - Group D and Group C. Group D patients received DEX infusion at a rate of 1 μg/kg for the first 10 min followed by 0.5 μg/kg/h and Group C received 0.9% normal saline infusion in the same manner. Airway blocks with lignocaine were given to all patients before undergoing AFOI. Patient's alertness, sedation and cardiorespiratory changes during the procedure were assessed by the Observer Assessment Awareness and Sedation (OAA/S) scale. On the 1st post-operative day, patient's' comfort during AFOI was assessed by visual analogue scale (VAS). Results: Patients of Group D had an acceptable level of sedation (OAA/S score: 20 to 17 with greater comfort and satisfaction (VAS: 40–60), compared to control group (VAS: 50–90, P < 0.001.). Moreover, haemodynamic parameters were less significantly altered in the DEX group during AFOI. Conclusions: IV DEX infusion during AFOI improves patient's tolerances with an acceptable level of sedation without significant haemodynamic instability and respiratory depression.
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Affiliation(s)
- Saikat Niyogi
- Department of Anesthesia, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Samir Basak
- Department of Anaesthesia, Central Hospital, Kolkata, West Bengal, India
| | - Amita Acharjee
- Department of Anesthesia, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Indrani Chakraborty
- Department of Anesthesia, Bangur Institute of Neurosciences, Kolkata, West Bengal, India
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Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative disease that represents the most common spinal cord disorder in adults. The natural history of the disease can be insidious, and patients often develop debilitating spasticity and weakness. Diagnosis includes a combination of physical examination and various imaging modalities. There are various surgical options for CSM, consisting of anterior and posterior procedures. This article summarizes the literature regarding the pathophysiology, natural history, and diagnosis of CSM, as well as the various treatment options and their associated risks and indications.
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77
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An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature. World Neurosurg 2016; 94:97-110. [DOI: 10.1016/j.wneu.2016.06.109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 06/25/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022]
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Wu ZK, Zhao QH, Tian JW, Qian YB, Zhou Y, Yang F, Zhao L, Porter DE. Anterior versus posterior approach for multilevel cervical spondylotic myelopathy. Hippokratia 2016. [DOI: 10.1002/14651858.cd012365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Zhen-kai Wu
- Xin-Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine; Department of Pediatric Orthopaedics; No. 1665, Kongjiang Road Shanghai China 200092
| | - Qing-hua Zhao
- Shanghai First People's Hospital; Department of Spinal Surgery; 100 Haining Road Shanghai China 200080
| | - Ji-wei Tian
- Shanghai First People's Hospital; Department of Spinal Surgery; 100 Haining Road Shanghai China 200080
| | - Yong-bing Qian
- Shanghai First People's Hospital; Department of Trauma Surgery and Critical Care; 100 Haining Road Shanghai China 200080
| | - Yi Zhou
- Shanghai First People's Hospital; Department of Nephropathy; 100 Haining Road Shanghai China 200080
| | - Fan Yang
- University of Nebraska-Lincoln; Department of Statistics; Lincoln NE USA
| | - Li Zhao
- Xin-Hua Hospital affiliated to Shanghai Jiaotong University School of Medicine; Department of Pediatric Orthopaedics; No. 1665, Kongjiang Road Shanghai China 200092
| | - Daniel E Porter
- First Affiliated Hospital of Tsinguha University; JiuXianQiao Rd, ChaoYang Beijing China 100016
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Kim TH, Ha Y, Shin JJ, Cho YE, Lee JH, Cho WH. Signal intensity ratio on magnetic resonance imaging as a prognostic factor in patients with cervical compressive myelopathy. Medicine (Baltimore) 2016; 95:e4649. [PMID: 27684796 PMCID: PMC5265889 DOI: 10.1097/md.0000000000004649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Patients with intramedullary signal intensity (SI) changes have a poor prognosis after surgical decompression in cervical compressive myelopathy (CCM); however, some patients show no clear relationship between the SI and postsurgical prognosis. This discrepancy may be because no comprehensive and proper quantitative evaluation exists to assess SI on magnetic resonance imaging (MRI). The purpose of this study was prospectively to evaluate the correlation between the clinical features, neurological outcome of patients with CCM, and the quantitative assessment of SI changes preoperatively and postoperatively, and the correlation with SI severity.A total of 112 patients with CCM at 1 or 2 levels underwent anterior cervical discectomy and fusion. We quantitatively analyzed MR signal changes on T1-weighted MR images (T1WI), gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast-enhanced T1WI, and T2-weighted MR images (T2WI) using the signal intensity ratio (SIR). We evaluated the correlations between various variables and neurological outcome using the Japanese Orthopedic Association (JOA) scale, and the severity of SI change by grade (i.e., grade 0 ["none"], grade 1 ["light"], and grade 2 ["bright on T2WI"]).Significant differences between the 3 grades existed in symptom duration, preoperative JOA score, SIR on T2WI, and JOA recovery ratio. The JOA recovery ratio was negatively correlated with symptom duration and the SIR on T2WI, and positively correlated with the preoperative JOA score and cord compression ratio, but not with the SIR on T1WI and contrast-enhanced T1WI. On the postoperative 12-month follow-up MRI, the JOA recovery ratio and SIR on T2WI of the SI reversal patients were better than those of the nonreversal patients. On multiple regression analysis, the SIR on T2WI was the main significant prognostic factor of surgical outcome.The grading system on T2WI provided reliable predictive information for neurological outcome. Quantitative alterations in the SI on preoperative and postoperative T2WI, but not T1WI or contrast-enhanced T1WI, reflected the clinical features, surgical outcomes, and the correlation with SI severity. The patients with a longer duration of symptoms, lower cord compression ratio, severe myelopathy, intense signal change (i.e., grade 2) on the spinal cord, and an SIR greater than 1.55 had a poor recovery after a surgical operation.
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Affiliation(s)
- Tae Hyun Kim
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine
| | - Yoon Ha
- Department of Neurosurgery, Yonsei University College of Medicine
| | - Jun Jae Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine
- Correspondence: Jun Jae Shin, Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Dongil-ro 1342, Nowon-gu, Seoul 01757, Korea (e-mail: )
| | - Yong Eun Cho
- Department of Neurosurgery, Yonsei University College of Medicine
| | - Ji Hae Lee
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Woo Ho Cho
- Department of Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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Perioperative Outcomes After Cervical Laminoplasty Versus Posterior Decompression and Fusion: Analysis of 779 Patients in the ACS-NSQIP Database. Clin Spine Surg 2016; 29:E226-32. [PMID: 25310393 DOI: 10.1097/bsd.0000000000000183] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare the short-term outcomes for patients undergoing cervical laminoplasty versus posterior decompression and fusion for multilevel cervical pathology. SUMMARY OF BACKGROUND DATA There are conflicting data regarding the merits of cervical laminoplasty and posterior decompression and fusion for the treatment of multilevel cervical pathology. METHODS Patients who underwent cervical laminoplasty or posterior decompression and fusion were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2010 to 2012. Baseline patient characteristics were compared using bivariate logistic regression. Propensity-adjusted multivariate regressions were performed to assess differences in postoperative length of stay, adverse events, and 30-day readmission. RESULTS A total of 779 patients were included in this study: 437 (56.1%) underwent cervical decompression and fusion and 342 (43.9%) underwent cervical laminoplasty. Decompression and fusion patients were found to be more comorbid at baseline than laminoplasty patients based on increased American Society of Anesthesiologists scores and Charlson Comorbidity Index.Propensity-adjusted multivariate analysis was used to control for differences in baseline patient characteristics, and found that compared with laminoplasty patients, decompression and fusion patients had increased length of stay (+1.2 d, P<0.001), greater rates of any adverse event (OR=1.7, P=0.018), and were more likely to be readmitted (OR=2.3, P=0.028). CONCLUSIONS Posterior cervical decompression and fusion patients were found to have moderately worse short-term outcomes than laminoplasty patients. The information provided here can be used to inform patients and surgeons about the likely perioperative experience after they have made the decision to pursue 1 of these 2 procedures.
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81
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The contribution of neurophysiology in the diagnosis and management of cervical spondylotic myelopathy: a review. Spinal Cord 2016; 54:756-766. [PMID: 27241448 DOI: 10.1038/sc.2016.82] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
STUDY DESIGN Topical review of the literature. OBJECTIVE The objective of this review article was to assess indications and usefulness of various neurophysiological techniques in diagnosis and management of cervical spondylogenic myelopathy (CSM). METHODS The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: 'compressive myelopathy', 'cervical spondylotic myelopathy (CSM)', 'cervical spondylogenic myelopathy', 'motor evoked potentials (MEPs)', 'transcranial magnetic stimulation', 'somatosensory evoked potentials (SEPs)', 'electromyography (EMG)', 'nerve conduction studies (NCS)' and 'cutaneous silent period (CSP)'. RESULTS SEPs and MEPs recording can usefully supplement clinical examination and neuroimaging findings in assessing the spinal cord injury level and severity. Segmental cervical cord dysfunction can be revealed by an abnormal spinal N13 response, whereas the P14 potential is a reliable marker of dorsal column impairment. MEPs may also help in the differential diagnosis between spinal cord compression and neurodegenerative disorders. SEPs and MEPs are also useful in follow-up evaluation of sensory and motor function during surgical treatment and rehabilitation. EMG and NCS improve the sensitivity of cervical radiculopathy detection and may help rule out peripheral nerve problems that can cause symptoms that are similar to those of CSM. CSP also shows a high sensitivity for detecting CSM. CONCLUSION Neuroimaging, especially magnetic resonance imaging, represents the procedure of choice for the diagnosis of CSM, but a correct interpretation of morphological findings can be achieved only if they are correlated with functional data. The studies reported in this review highlight the crucial role of the electrophysiological studies in diagnosis and management of CSM.
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Abstract
Cervical spondylotic myelopathy is a complex condition with subtle history and examination findings that mimic other conditions. Primary care physician assistants often are the first providers to evaluate these patients. This article describes cervical spondylotic myelopathy, its diagnosis and management, and recent data that offer strong evidence that patients who undergo surgical decompression show significant improvement over patients who are treated conservatively.
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83
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El-Zuway S, Farrokhyar F, Kachur E. Myelopathic signs and functional outcome following cervical decompression surgery: a proposed myelopathy scale. J Neurosurg Spine 2016; 24:871-7. [PMID: 26849710 DOI: 10.3171/2015.9.spine139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. In spite of this, the impact of the changes in myelopathic signs following cervical decompression surgery and their relationship to functional outcome measures remains unclear. The main goals of our study were to prospectively assess changes in myelopathic signs with a functional outcome scale (the modified Japanese Orthopaedic Association [mJOA] scale) following cervical decompression surgery and to objectively test a proposed new myelopathy scale (MS). METHODS Between 2008 and 2011, 36 patients with CSM were observed following cervical decompression surgery. Patient data including mJOA and MS scores were prospectively collected and analyzed preoperatively and at 1 year after surgery. RESULTS In this cohort, reflex, Babinski, and proprioception signs showed statistically significant improvement following surgery at 1 year (p = < 0.001, p = 0.008, and p = 0.015, respectively). A lesser degree of improvement was observed with the Hoffman sign (p = 0.091). No statistically significant improvement in clonus occurred (p = 0.368). There was a significant improvement in mJOA (p ≤ 0.001) and MS (p ≤ 0.001) scores at 1 year compared with the preoperative scores. The results showed an inverse correlation between MS and mJOA scores both pre- and postoperatively (Spearman's correlation coefficient = -0.202 preoperatively and -0.361 postoperatively). CONCLUSIONS Improvement in myelopathic signs was noted following cervical decompression surgery in patients with CSM. The newly devised MS scale demonstrated these findings, and the new MS scale correlates with improvement in mJOA scores in this patient cohort.
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Affiliation(s)
- Salem El-Zuway
- Division of Neurosurgery, Department of Surgery.,Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University; and
| | - Edward Kachur
- Division of Neurosurgery, Department of Surgery.,Hamilton Health Sciences, Hamilton, Ontario, Canada
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Fei Q, Li J, Su N, Wang B, Li D, Meng H, Wang Q, Lin J, Ma Z, Yang Y. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis. Ther Clin Risk Manag 2015; 11:1707-18. [PMID: 26604771 PMCID: PMC4655946 DOI: 10.2147/tcrm.s94290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Whether anterior cervical discectomy with fusion (ACDF) or anterior cervical corpectomy with fusion (ACCF) is superior in the treatment of cervical spondylotic myelopathy remains controversial. Therefore, we conducted a meta-analysis to quantitatively compare the efficacy and safety of ACDF and ACCF in the treatment of cervical spondylotic myelopathy. METHODS PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, People's Republic of China), and CNKI (China National Knowledge Infrastructure, People's Republic of China) were systematically searched to identify all available studies comparing efficacy and safety between patients receiving ACDF and ACCF. The weighted mean difference (WMD) was pooled to compare the Japanese Orthopaedic Association scores, visual analog scale scores, hospital stay, operation time, and blood loss. The risk ratio was pooled to compare the incidence of complications and fusion rate. Pooled estimates were calculated by using a fixed-effects model or a random-effects model according to the heterogeneity among studies. RESULTS Eighteen studies (17 observational studies and one randomized controlled trial) were included in this meta-analysis. Our results suggest that hospital stay (WMD =-1.33, 95% confidence interval [CI]: -2.29, -0.27; P=0.014), operation time (WMD =-26.9, 95% CI: -46.13, -7.67; P=0.006), blood loss (WMD =-119.36, 95% CI: -166.94, -71.77; P=0.000), and incidence of complications (risk ratio =0.51, 95% CI: 0.33, 0.80; P=0.003) in the ACDF group were significantly less than that in the ACCF group. However, other clinical outcomes, including post-Japanese Orthopaedic Association score (WMD =-0.27, 95% CI: -0.57, 0.03; P=0.075), visual analog scale score (WMD =0.03, 95% CI: -1.44, 1.50; P=0.970), and fusion rate (risk ratio =1.04, 95% CI: 0.99, 1.09; P=0.158), between the two groups were not significantly different. CONCLUSION Evidence from the meta-analysis of 18 studies demonstrated that surgical options of cervical spondylotic myelopathy using ACDF or ACCF seemed to have similar clinical outcomes. However, ACDF was found to be superior to ACCF in terms of hospital stay, operation time, blood loss, and incidence of complications.
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Affiliation(s)
- Qi Fei
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jinjun Li
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Nan Su
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Bingqiang Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Dong Li
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hai Meng
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qi Wang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jisheng Lin
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Zhao Ma
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yong Yang
- Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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Tan B, Wang H, Dong J, Yuan Z, Wang D, Wang F. Comparison of rhBMP-2 versus Autogenous Iliac Crest Bone Graft for 2-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy. Med Sci Monit 2015; 21:3159-65. [PMID: 26479708 PMCID: PMC4617188 DOI: 10.12659/msm.894656] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Few studies have examined the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) in 2-level anterior cervical discectomy and fusion (ACDF). The purpose of this study was to compare the outcomes in a series of patients with CSM treated with 2-level ACDF with or without rhBMP-2. Material/Methods The retrospective study included a total of 146 patients with CSM. The rhBMP-2 group consisted of 73 patients who underwent 2-level ACDF with rhBMP-2. A total of 73 patients who also received 2-level ACDF with autogenous ICBG alone were included in the matched-pair ICBG group with a ratio of 1:1, based on age, sex, and BMI. All data, including fusion rate and time, VAS, JOA score, operative date, and complications, were assessed. Results With respect to the length of hospital stay, operative times, and blood loss, there were no significant difference between the 2 groups. However, the rhBMP-2 group presented a shorter fusion time (P<0.013) and higher fusion rate (P<0.036) than the ICBG group. In the rhBMP-2 group, 22% required additional treatment for complications compared to 18% of patients in the ICBG group, which showed no significant difference (P=0.543). Conclusions The application of rhBMP-2 in 2-level ACDF showed higher fusion rates, shorter fusion time, and similar function outcomes compared to those who received ACDF with ICBG alone.
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Affiliation(s)
- Bingyi Tan
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Haiyan Wang
- Shandong Medical Image Research Institute, Shandong University, Jinan, Shandong, China (mainland)
| | - Jun Dong
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Zenong Yuan
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Dachuan Wang
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
| | - Feng Wang
- Department of Spinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China (mainland)
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86
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Ulrich A, Min K, Curt A. High sensitivity of contact-heat evoked potentials in “snake-eye” appearance myelopathy. Clin Neurophysiol 2015; 126:1994-2003. [DOI: 10.1016/j.clinph.2014.12.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 11/30/2014] [Accepted: 12/10/2014] [Indexed: 12/12/2022]
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Li ZQ, Zhao YP, Jia WY, Wang X, Chen B, Shahbaz M, Nie L, Cheng L. Surgical Treatment of Cervical Spondylotic Myelopathy Associated Hypertension--A Retrospective Study of 309 Patients. PLoS One 2015; 10:e0133828. [PMID: 26193469 PMCID: PMC4508105 DOI: 10.1371/journal.pone.0133828] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 07/02/2015] [Indexed: 01/21/2023] Open
Abstract
Hypertension is the most prevalent cardiovascular disease, and various risk factors are known to be involved in it. Cervical spondylotic myelopathy (CSM) is the most common non-traumatic cause of myelopathy, which displays neurological symptoms and may induce systemic symptoms. To date, it is still unknown whether CSM is associated with hypertension, and if so, whether the decompression operations can attenuate CSM associated hypertension. Here, a total of 309 patients with CSM who received anterior or posterior decompression surgery were enrolled as subjects. Blood pressure measurements were performed before and within one week after the surgery. Among the 309 subjects, 144 (46.6%) of them exhibited hypertension before surgery, a significantly higher ratio than that of the whole population. One week after surgery, blood pressure of 106 (73.6%) patients turned back to normal. Blood pressure of another 37(25.7%) patients decreased with different degrees, although still higher than normal. Moreover, it appears that both approaches were effective in improving blood pressure, while the posterior approach was more effective in decreasing systolic blood pressure. We speculate this type of hypertension might result from hyperactivity of sympathetic nervous system as the heart rate of these patients decreased after surgery as well. Collectively, compression of spinal cord in CSM patients might be associated with hypertension, and decompression surgery largely attenuated this type of hypertension. These findings prove CSM to be a potential associated factor of high blood pressure and may shed light on therapies of hypertension in clinics.
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Affiliation(s)
- Ze-qun Li
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Yun-peng Zhao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Wen-yu Jia
- Department of Endocrinology and Metabolism, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong Province, P. R. China
- Institute of Endocrinology, Shandong Academy of Clinical Medicine, Jinan, Shandong Province, P. R. China
| | - Xia Wang
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Bin Chen
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Muhammad Shahbaz
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
| | - Lin Nie
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
- * E-mail: (LN); (LC)
| | - Lei Cheng
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, P. R. China
- * E-mail: (LN); (LC)
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Use of multivariate linear regression and support vector regression to predict functional outcome after surgery for cervical spondylotic myelopathy. J Clin Neurosci 2015; 22:1444-9. [PMID: 26115898 DOI: 10.1016/j.jocn.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/05/2015] [Indexed: 11/24/2022]
Abstract
This study introduces the use of multivariate linear regression (MLR) and support vector regression (SVR) models to predict postoperative outcomes in a cohort of patients who underwent surgery for cervical spondylotic myelopathy (CSM). Currently, predicting outcomes after surgery for CSM remains a challenge. We recruited patients who had a diagnosis of CSM and required decompressive surgery with or without fusion. Fine motor function was tested preoperatively and postoperatively with a handgrip-based tracking device that has been previously validated, yielding mean absolute accuracy (MAA) results for two tracking tasks (sinusoidal and step). All patients completed Oswestry disability index (ODI) and modified Japanese Orthopaedic Association questionnaires preoperatively and postoperatively. Preoperative data was utilized in MLR and SVR models to predict postoperative ODI. Predictions were compared to the actual ODI scores with the coefficient of determination (R(2)) and mean absolute difference (MAD). From this, 20 patients met the inclusion criteria and completed follow-up at least 3 months after surgery. With the MLR model, a combination of the preoperative ODI score, preoperative MAA (step function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.452; MAD=0.0887; p=1.17 × 10(-3)). With the SVR model, a combination of preoperative ODI score, preoperative MAA (sinusoidal function), and symptom duration yielded the best prediction of postoperative ODI (R(2)=0.932; MAD=0.0283; p=5.73 × 10(-12)). The SVR model was more accurate than the MLR model. The SVR can be used preoperatively in risk/benefit analysis and the decision to operate.
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Wen ZQ, Du JY, Ling ZH, Xu HD, Lin XJ. Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of multilevel cervical spondylotic myelopathy: systematic review and a meta-analysis. Ther Clin Risk Manag 2015; 11:161-70. [PMID: 25673996 PMCID: PMC4321642 DOI: 10.2147/tcrm.s72699] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To date, the decision to treat multilevel cervical spondylotic myelopathy (CSM) with anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion (ACCF) remains controversial. Therefore, we conducted a meta-analysis to quantitatively determine the efficacy of ACDF and ACCF in the treatment of multilevel CSM. METHODS We searched several databases for related research articles published in English or Chinese. We extracted and assessed the data independently. We determined the pooled data, data heterogeneity, and overall effect, respectively. RESULTS We identified 15 eligible studies with 1,368 patients. We found that blood loss and numbers of complications during surgery in ACDF were significantly less that in ACCF; however, other clinical outcomes, such as operation time, bone fusion failure, post Japanese Orthopedic Association scores, recovery rates, and visual analog scale scores between ACDF and ACCF with multilevel CSM were not significantly different. CONCLUSION Our results strongly suggest that surgical treatments of multilevel CSM are similar in terms of most clinical outcomes using ACDF or ACCF.
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Affiliation(s)
- Zhi-Qiang Wen
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Jing-Yu Du
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Zhi-Heng Ling
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
| | - Hai-Dong Xu
- Department of Spine Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, People's Republic of China
| | - Xiang-Jin Lin
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China
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Quinn JC, Kiely PD, Lebl DR, Hughes AP. Anterior surgical treatment of cervical spondylotic myelopathy: review article. HSS J 2015; 11:15-25. [PMID: 25737664 PMCID: PMC4342400 DOI: 10.1007/s11420-014-9408-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 07/03/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a common indication for cervical spine surgery. Surgical options include anterior, posterior, or combined procedures each with specific advantages and disadvantages. QUESTIONS/PURPOSES This article will provide a description of the various anterior alternatives and discuss the available evidence used in guiding the surgical decision making process with the aim of answering the following questions: (1) What anatomical/disease related factors favor anterior over posterior surgeries? (2) What are the common anterior procedures and how safe and effective are they? (3) What are the most effective options for multilevel CSM? (4) Is there a role for motion preservation? An additional objective is to discuss technical advances that have improved success rates for anterior procedures. METHODS The PubMed database was searched. Keywords were CSM and anterior surgery. Three hundred eighty two articles were found one hundred three were reviewed. Articles describing anterior cervical techniques were selected along with studies describing the various anterior techniques or comparisons of anterior to posterior techniques. RESULTS Anterior decompression and fusion procedures are more effective than posterior procedures for patients with primarily ventrally located compression especially in the presence of cervical kyphosis. ACDF, ACCF, and hybrid combinations are safe and effective treatment options for multilevel CSM. Anterior procedures may be more cost effective and result in significantly improved postoperative quality of life and health-related quality of life measures compared to posterior procedures. CONCLUSION Anterior cervical decompression techniques are safe and effective in the treatment of CSM. Anterior surgeries may be preferable to posterior approaches, when considering health-related quality of life measures and cost effectiveness.
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Affiliation(s)
- John C. Quinn
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Paul D. Kiely
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Darren R. Lebl
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Kim SD, Ha HG, Lee CY, Kim HW, Jung CK, Kim JH. Cervical cord decompression using extended anterior cervical foraminotomy technique. J Korean Neurosurg Soc 2014; 56:114-20. [PMID: 25328648 PMCID: PMC4200358 DOI: 10.3340/jkns.2014.56.2.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/04/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. METHODS Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. RESULTS In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was 9.77 mm(2) (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. CONCLUSIONS Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.
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Affiliation(s)
- Sung-Duk Kim
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera
| | - Ho-Gyun Ha
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera. ; Department of Neurosurgery, Teun Teun Hospital, Daejon, Korea
| | - Cheol-Young Lee
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera
| | - Hyun-Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera
| | - Chul-Ku Jung
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera
| | - Jong Hyun Kim
- Department of Neurosurgery, Konyang University Hospital, Daejon, Koera
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Translation, cross-cultural adaptation, and validation of a Chinese version of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. Spine (Phila Pa 1976) 2014; 39:963-70. [PMID: 24718075 DOI: 10.1097/brs.0000000000000313] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Translation and psychometric testing of a questionnaire. OBJECTIVE To adapt the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) cross-culturally to Chinese language and to investigate the psychometric properties of the translated Chinese JOACMEQ. SUMMARY OF BACKGROUND DATA The recently developed JOACMEQ is a self-reported questionnaire used to assess the severity of the cervical spondylotic myelopathy. Despite its acceptance in the literature, the JOACMEQ has not been translated and validated for Chinese-speaking patients. METHODS Translation and cross-cultural adaptation of the original JOACMEQ was performed according to published guidelines. A total of 105 patients with a predominant complain of neck pain that included but not limited to patients with a clinically confirmed cervical spondylotic myelopathy were included. Psychometric testing of the responses included construct validity (factor analysis), internal consistency (Cronbach α), test-retest reproducibility (intraclass correlation coefficient), and concurrent validity (Spearman ρ). The discriminatory power of differentiating those with myelopathy from those without was assessed by the area under the receiver operating characteristic curve and with the optimal cutoff points determined. RESULTS Construct validity testing revealed a comparable factorial structure of the Chinese JOACMEQ with the original JOACMEQ. The Cronbach α of the Chinese JOACMEQ was 0.88, indicating good internal consistency. Good to excellent test-retest reliability was demonstrated for all 5 domain scores (intraclass correlation coefficient range = 0.79-0.90). A significant strong association between the Chinese Neck Disability Index and the quality of life domain of the Chinese JOACMEQ (Spearman ρ= -0.76, P < 0.01) was identified. The upper and lower extremity function domain scores were found to be significant, with the area under the receiver operating characteristic curve found to be 0.75 (P = 0.04) and 0.82 (P = 0.02), respectively. CONCLUSION The results indicated that the Chinese JOACMEQ successfully retained the psychometric properties of the original JOACMEQ and support the usefulness of the Chinese JOACMEQ as an appropriate supplementary diagnostic and outcome measure for Chinese patients suspected of cervical spondylotic myelopathy.
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93
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Anterior fusion technique for multilevel cervical spondylotic myelopathy: a retrospective analysis of surgical outcome of patients with different number of levels fused. PLoS One 2014; 9:e91329. [PMID: 24618678 PMCID: PMC3949986 DOI: 10.1371/journal.pone.0091329] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/08/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The anterior approach for multilevel CSM has been developed and obtained favorable outcomes. However, the operation difficulty, invasiveness and operative risks increase when multi-level involved. This study was to assess surgical parameters, complications, clinical and radiological outcomes in the treatment of 2-, 3- and 4-level CSM. METHODS A total of 248 patients with 2-, 3- or 4-level CSM who underwent anterior decompression and fusion procedures between October 2005 and June 2011 were divided into three groups, the 2-level group (106 patients), the 3-level group (98 patients) and the 4-level group (44 patients). The clinical and Radiographic outcomes including Japanese Orthopedic Association (JOA) score, Neck Disability Index (NDI) score, Odom's Scale, hospital stay, blood loss, operation time, fusion rate, cervical lordosis, cervical range of motion (ROM), and complications were compared. RESULTS At a minimum of 2-year follow-up, no statistical differences in JOA score, NDI score, Odom's Scale, hospital stay, fusion rate and cervical lordosis were found among the 3 groups. However, the mean postoperative NDI score of the 4-level group was significantly higher than that in the other two groups (P<0.05), and in terms of postoperative total ROM, the 3-level group was superior to the 4-level group and inferior to 2-level group (P<0.05). The decrease rate of ROM in the 3-level group was significantly higher than that in the 2-level group, and lower than that in the 4-level group (P<0.05). CONCLUSIONS As the number of involved levels increased, surgical results become worse in terms of operative time, blood loss, NDI score, cervical ROM and complication rates postoperatively. An appropriate surgical procedure for multilevel CSM should be chosen according to comprehensive clinical evaluation before operation, thus reducing fusion and decompression levels if possible.
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94
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Kim CH, Chung CK, Kim KJ, Park SB, Lee SJ, Yoon SH, Park BJ. Cervical extension magnetic resonance imaging in evaluating cervical spondylotic myelopathy. Acta Neurochir (Wien) 2014; 156:259-66. [PMID: 24287683 DOI: 10.1007/s00701-013-1951-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 11/13/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) may be caused by static and dynamic spinal cord compression, particularly during neck extension. Dynamic compression may be better evaluated with dynamic magnetic resonance (MR) images. We performed a retrospective study to determine the clinical indication for dynamic MR imaging, and conducted a survey regarding image interpretation by clinicians. METHOD A total of 32 patients (M:F = 20:12, 60.1 ± 10.7 years) who had undergone neutral/extension cervical MR imaging were included. The study population consisted of 22 patients with signs of cervical myelopathy (M group) and 10 patients without signs of myelopathy (NM group). The number of compression levels (complete obliteration of the anterior and posterior subarachnoid space) was assessed at each level in mid-sagittal, T2-weighted, neutral and extension MR images. Reproduced images from 22 patients in the M group were randomly arranged, and four experienced spine surgeons at four different institutes interpreted them to reach a clinicians' agreement. The agreements were then assessed with inter-rater correlation coefficients (ICC). RESULTS Analysis with extension MR images found an increased number of compression levels in 23/32 (72 %) of patients; 20/22 in the M group and 3/10 in the NM group (p < 0.01, chi-squared test), as compared to findings of the neutral MR images. Clinical factors for increased compression levels in extension MR images were age (p < 0.01, 63.3 ± 10.0 years vs. 51.9 ± 8.1) and signs of myelopathy (p < 0.01, odds ratio, 23.33). Clinician agreement was improved with extension MR images; ICC was 0.67 with neutral and 0.81 with extension MR images. CONCLUSIONS The evaluation of CSM may be improved with dynamic MR images. Dynamic MR scanning may be considered for elderly patients with signs of myelopathy, but an interpretation for asymptomatic spinal compression based exclusively on extension MR image should be made with caution.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine and Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, South Korea
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95
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Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J. Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis. PLoS One 2014; 9:e87191. [PMID: 24489868 PMCID: PMC3905022 DOI: 10.1371/journal.pone.0087191] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/18/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Both anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) are used to treat cervical spondylotic myelopathy (CSM), however, there is considerable controversy as to whether ACDF or ACCF is the optimal treatment for this condition. To compare the clinical outcomes, complications, and surgical trauma between ACDF and ACCF for the treatment of CSM, we conducted a meta-analysis. METHODS We conducted a comprehensive search in MEDLINE, EMBASE, PubMed, Google Scholar and Cochrane databases, searching for relevant controlled trials up to July 2013 that compared ACDF and ACCF for the treatment of CSM. We performed title and abstract screening and full-text screening independently and in duplicate. A random effects model was used for heterogeneous data; otherwise, a fixed effect model was used to pool data, using mean difference (MD) for continuous outcomes and odds ratio (OR) for dichotomous outcomes. RESULTS Of 2157 citations examined, 15 articles representing 1372 participants were eligible. Overall, there were significant differences between the two treatment groups for hospital stay (M = -5.60, 95% CI = -7.09 to -4.11), blood loss (MD = -151.35, 95% CI = -253.22 to -49.48), complications (OR = 0.50, 95% CI = 0.35 to 0.73) and increased lordosis of C2-C7 (MD = 3.70, 95% CI = 0.96 to 6.45) and fusion segments angles (MD = 3.38, 95% CI = 2.54 to 4.22). However, there were no significant differences in the operation time (MD = -9.34, 95% CI = -42.99 to 24.31), JOA (MD = 0.24, 95% CI = -0.10 to 0.57), VAS (MD = -0.06, 95% CI = -0.81 to 0.70), NDI (MD = -1.37, 95% CI = -3.17 to 0.43), Odom criteria (OR = 0.88, 95% CI = 0.60 to 1.30) or fusion rate (OR = 1.17, 95% CI = 0.34 to 4.11). CONCLUSIONS Based on this meta-analysis, although complications and increased lordosis are significantly better in the ACDF group, there is no strong evidence to support the routine use of ACDF over ACCF in CSM.
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Affiliation(s)
- Ying-Chao Han
- Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhu-Qing Liu
- Department of Medical Oncology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Li-Jun Li
- Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Tan
- Department of Spinal Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
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96
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Huang SQ, Tang CL, Sun SQ, Yang C, Xu J, Wang KJ, Lu WT, Huang J, Zhuo F, Qiu GP, Wu XY, Qi W. Demyelination initiated by oligodendrocyte apoptosis through enhancing endoplasmic reticulum-mitochondria interactions and Id2 expression after compressed spinal cord injury in rats. CNS Neurosci Ther 2013; 20:20-31. [PMID: 23937638 DOI: 10.1111/cns.12155] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 06/21/2013] [Accepted: 06/24/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Demyelination is one of the most important pathological factors of spinal cord injury. Oligodendrocyte apoptosis is involved in triggering demyelination. However, fewer reports on pathological changes and mechanism of demyelination have been presented from compressed spinal cord injury (CSCI). The relative effect of oligodendrocyte apoptosis on CSCI-induced demyelination and the mechanism of apoptosis remain unclear. AIMS In this study, a custom-designed model of CSCI was used to determine whether or not demyelination and oligodendrocyte apoptosis occur after CSCI. The pathological changes in axonal myelinated fibers were investigated by osmic acid staining and transmission electron microscopy. Myelin basic protein (MBP), which is used in myelin formation in the central nervous system, was detected by immunofluorescence and Western blot assays. Oligodendrocyte apoptosis was revealed by in situ terminal-deoxytransferase-mediated dUTP nick-end labeling. To analyze the mechanism of oligodendrocyte apoptosis, we detected caspase-12 [a representative of endoplasmic reticulum (ER) stress], cytochrome c (an apoptotic factor and hallmark of mitochondria), and inhibitor of DNA binding 2 (Id2, an oligodendrocyte lineage gene) by immunofluorescence and Western blot assays. RESULTS The custom-designed model of CSCI was successfully established. The rats were spastic, paralyzed, and incontinent. The Basso, Beattie, and Bresnahan (BBB) locomotor rating scale scores were decreased as time passed. The compressed spinal cord slices were ischemic. Myelin sheaths became swollen and degenerative; these sheaths were broken down as time passed after CSCI. MBP expression was downregulated after CSCI and consistent with the degree of demyelination. Oligodendrocyte apoptosis occurred at 1 day after CSCI and increased as caspase-12 expression was enhanced and cytochrome c was released. Id2 was distributed widely in the white matter. Id2 expression increased with time after CSCI. CONCLUSION Demyelination occurred after CSCI and might be partly caused by oligodendrocyte apoptosis, which was positively correlated with ER-mitochondria interactions and enhanced Id2 expression after CSCI in rats.
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Affiliation(s)
- Si-Qin Huang
- Traditional Chinese Medicine College, Chongqing Medical University, Chongqing, China; Institute of Neuroscience, Chongqing Medical University, Chongqing, China
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97
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Wu JC, Ko CC, Yen YS, Huang WC, Chen YC, Liu L, Tu TH, Lo SS, Cheng H. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus 2013; 35:E10. [PMID: 23815246 DOI: 10.3171/2013.4.focus13122] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
This study aimed to determine the age- and sex-specific incidence of cervical spondylotic myelopathy (CSM) and its associated risk of causing subsequent spinal cord injury (SCI).
Methods
Using the National Health Insurance Research Database (NHIRD), a 12-year nationwide database in Taiwan, this retrospective cohort study analyzed the incidence of hospitalization caused by CSM. All patients diagnosed with and admitted for CSM were identified during the study period. The CSM patients were divided into 2 groups, a control group and an operated group. An incidence density method was used to estimate age- and sex-specific incidence rates of CSM. The Kaplan-Meier method and Cox regression analyses were performed to compare the risk of SCI between the 2 groups.
Results
From 1998 to 2009, covering 349.5 million person-years, 14,140 patients were hospitalized for CSM. The overall incidence of CSM-related hospitalization was 4.04 per 100,000 person-years. Specifically, males and older persons had a higher incidence rate of CSM. During the follow-up of these patients for 13,461 person-years, a total of 166 patients were diagnosed with SCI. The incidence of SCI was higher in the control group than the operated group (13.9 vs 9.4 per 1000 person-years, respectively). During the follow-up, SCI was more likely to occur in CSM patients who were treated conservatively (crude HR 1.48, p = 0.023; adjusted HR 1.57, p = 0.011) than in those who underwent surgery for CSM.
Conclusions
In a national cohort of eastern Asia, the incidence of CSM-caused hospitalization was 4.04 per 100,000 person-years, with higher incidences observed in older and male patients. Subsequent SCI was more likely to develop in patients who received nonoperative management than in those who underwent surgery. Therefore, patients with CSM managed without surgery should be cautioned about SCI. However, further investigations are still required to clarify the risks and complications associated with surgery for CSM.
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Affiliation(s)
- Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
- 3Institute of Pharmacology, and
| | - Chin-Chu Ko
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
- 3Institute of Pharmacology, and
| | - Yu-Shu Yen
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
| | - Yu-Chun Chen
- 2School of Medicine,
- 4Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan
- 5Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei
| | - Laura Liu
- 6Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan; and
- 7College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
| | | | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei
- 2School of Medicine,
- 3Institute of Pharmacology, and
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98
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Li J, Zheng Q, Guo X, Zeng X, Zou Z, Liu Y, Hao S. Anterior surgical options for the treatment of cervical spondylotic myelopathy in a long-term follow-up study. Arch Orthop Trauma Surg 2013; 133:745-51. [PMID: 23503888 DOI: 10.1007/s00402-013-1719-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To provide a basis for the choice of anterior surgery procedures in the treatment of cervical spondylotic myelopathy (CSM) through long-term follow-up. METHODS A consecutive series of 89 patients with CSM having complete follow-up data were analyzed retrospectively. All patients were treated with anterior cervical discectomy and fusion (ACDF), and anterior cervical corpectomy and fusion (ACCF) from July 2000 to June 2007. The lesions were located in one segment (n = 25), two segments (n = 56), and three segments (n = 8). Preoperative and postoperative, the C2-C7 angle, cervical intervertebral height, radiographic fusion status, result of the adjacent segment degeneration, the Japanese Orthopaedic Association (JOA), and the Short Form 36-item (SF36) questionnaire scores were used to evaluate the efficacy of the surgery. RESULTS According to the different compression conditions of the 89 cases, different anterior operation procedures were chosen and satisfactory results were achieved, indicating that direct anterior decompressions were thorough and effective. The follow-up period was 60-108 months, and the average was 79.6 months. The 5-year average symptom improvement rate, effectiveness rate, and fineness rate were 78.36 %, 100 % (89/89), and 86.52 % (77/89), respectively. CONCLUSIONS For CSM with compression coming from the front side, proper anterior decompression based on the specific conditions could directly eliminate the compression. Through long-term follow-up, the effect of decompression became observable.
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Affiliation(s)
- Jingfeng Li
- Department of Orthopedics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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99
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Long HQ, Li GS, Lin EJ, Xie WH, Chen WL, Luk KDK, Hu Y. Is the speed of chronic compression an important factor for chronic spinal cord injury rat model? Neurosci Lett 2013; 545:75-80. [DOI: 10.1016/j.neulet.2013.04.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/05/2013] [Accepted: 04/07/2013] [Indexed: 12/26/2022]
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Shunzhi Y, Zhonghai L, Fengning L, Zhi C, Tiesheng H. Surgical management of 4-level cervical spondylotic myelopathy. Orthopedics 2013; 36:e613-20. [PMID: 23672914 DOI: 10.3928/01477447-20130426-24] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The optimal surgical approach for 4-level cervical spondylotic myelopathy is controversial. The authors compared the clinical outcomes, radiographic changes, and complications of 53 patients who underwent either discontinuous corpectomy and fusion (DCF) with reservation of the middle vertebra (n=29) or laminectomy and fusion (n=24). Neurological function was measured using Nurick's grade and modified Japanese Orthopedic Association scores. The Neck Disability Index was recorded for neck-shoulder pain level evaluation. Patients' satisfaction with the surgery was evaluated using the Short Form 36. Segmental lordosis was measured. Both groups demonstrated significantly improved Nurick's grades and Japanese Orthopedic Association scores (P<.001), and the recovery rate was similar between the groups (59.86% ± 17.63% and 60.18% ± 12.01%, respectively). In terms of Neck Disability Index scores, Short Form 36 scores, and cervical lordosis measurements, no significant intergroup differences were found preoperatively. Mean postoperative Neck Disability Index scores were significantly lower in the DCF group (12.31 ± 1.91) than in the laminectomy group (15.04 ± 3.09; P=.000). Mean postoperative segmental lordosis was significantly higher in the DCF group (14.24 ± 2.29) than in the laminectomy group (9.96 ± 2.14; P=.001). The Short Form 36 scores significantly improved in both groups postoperatively (P<.01). Relative to the DCF group, the laminectomy group had a significantly longer operative time (192.25 ± 33.47 vs 192.25 ± 33.47 minutes, respectively; P<.01) and significantly more operative blood loss (455.41 ± 140.46 vs 253.79 ± 77.94 mL, respectively; P<.01). Discontinuous corpectomy and fusion with reservation of the middle vertebra is a safe and effective surgical treatment for 4-level cervical spondylotic myelopathy that results in significant functional improvement in most patients.
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Affiliation(s)
- Yu Shunzhi
- Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, the People’s Republic of China
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