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Liu Y, Zeng Z, Liu S. Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2024:10.1007/s00264-024-06278-2. [PMID: 39269485 DOI: 10.1007/s00264-024-06278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/08/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). METHODS One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively. RESULTS The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor one year outcome (JOA recovery rate < 50%). CONCLUSION Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing one year outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.
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Affiliation(s)
- Yibo Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring Road, Fengtai District, Beijing, 100070, China
| | - Zheng Zeng
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring Road, Fengtai District, Beijing, 100070, China.
| | - Shuanghe Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, 119 South Fourth Ring Road, Fengtai District, Beijing, 100070, China
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Wang H, Ye W, Xiong J, Gao Y, Ge X, Wang J, Zhu Y, Tang P, Zhou Y, Wang X, Gu Y, Liu W, Luo Y, Cai W. Application of Short T1 Inversion Recovery Sequence in Increased Signal Intensity Following Cervical Spondylotic Myelopathy. World Neurosurg 2024; 187:e1097-e1105. [PMID: 38762028 DOI: 10.1016/j.wneu.2024.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVES To compare magnetic resonance (MR) short T1 inversion recovery (STIR) sequence with MR T2-weighted (T2W) sequence for detecting increased signal intensity (ISI) and assessing outcomes of ISI in cervical spondylotic myelopathy (CSM). METHODS Data of patients with CSM who showed ISI on MR imaging and had undergone cervical spine surgery were retrospectively reviewed. STIR and T2W images were examined to assess signal intensity ratio (SIR), length and grading of the ISI, maximal spinal cord compression, canal narrowing ratio, and ligamentum flavum hypertrophy. The patients were divided into good and poor groups based on their outcomes. χ2 tests and variance analysis were used to assess intergroup differences. Univariate and multivariate logistic regression analyses were performed to identify risk factors for poor outcomes, and receiver operating characteristic curves were plotted to detect prognostic effects. RESULTS SIR and ISI lengths were significantly different between the STIR and T2 images. In the univariate logistic regression analysis, age, diabetes, SIRT2, SIRSTIR, and ISISTIR grading were significant factors. Accordingly, in the multivariate logistic regression analysis, age, diabetes, SIRT2, and SIRSTIR were included in the model. Among patients with diabetes, we observed a significant difference between SIRT2 and SIRSTIR. CONCLUSIONS The STIR sequence demonstrated superior capability to the T2W sequence in detecting ISI; however, there was no obvious difference in predicted outcomes. STIR sequence has a better prognostic value than T2W sequence in patients with diabetes who have CSM. ISI grading based on the STIR sequence may be a clinically valuable indicator.
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Affiliation(s)
- Haofan Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wu Ye
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Junjun Xiong
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yu Gao
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuhui Ge
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiaxing Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yufeng Zhu
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pengyu Tang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yitong Zhou
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaokun Wang
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yao Gu
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Liu
- Department of Orthopedics, Second Affiliated Hospital of Naval Medical University Shanghai, Shanghai, China
| | - Yongjun Luo
- Department of Orthopedics, Dushu Lake Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China
| | - Weihua Cai
- Department of Orthopedics, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Qu R, Wang B, Yang Y, Liu Z, Chen Z, Wu Y, Li X, Jiang L, Liu X, Liu Z. Would the one-stage combined approach lead to better long-term neurological outcomes than the posterior approach alone in multilevel degenerative cervical myelopathy patients with T2-Weighted increased signal intensity? An 8-year follow-up results and propensity score matching analysis. BMC Musculoskelet Disord 2024; 25:445. [PMID: 38844933 PMCID: PMC11155089 DOI: 10.1186/s12891-024-07554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/28/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND T2-weighted increased signal intensity (ISI) is commonly recognized as a sign of more severe spinal cord lesions, usually accompanied by worse neurological deficits and possibly worse postoperative neurological recovery. The combined approach could achieve better decompression and better neurological recovery for multilevel degenerative cervical myelopathy (MDCM). The choice of surgical approach for MDCM with intramedullary T2-weighted ISI remains disputed. This study aimed to compare the neurological outcomes of posterior and one-stage combined posteroanterior approaches for MDCM with T2-weighted ISI. METHODS A total of 83 consecutive MDCM patients with confirmed ISI with at least three intervertebral segments operated between 2012 and 2014 were retrospectively enrolled. Preoperative demographic, radiological and clinical condition variables were collected, and neurological conditions were evaluated by the Japanese Orthopedic Assessment score (JOA) and Neck Disability Index (NDI). Propensity score matching analysis was conducted to produce pairs of patients with comparable preoperative conditions from the posterior-alone and combined groups. Both short-term and mid-term surgical outcomes were evaluated, including the JOA recovery rate (JOARR), NDI improvements, complications, and reoperations. RESULTS A total of 83 patients were enrolled, of which 38 and 45 patients underwent posterior surgery alone and one-stage posteroanterior surgery, respectively. After propensity score matching, 38 pairs of comparable patients from the posterior and combined groups were matched. The matched groups presented similar preoperative clinical and radiological features and the mean follow-up duration were 111.6 ± 8.9 months. The preoperative JOA scores of the posterior and combined groups were 11.5 ± 2.2 and 11.1 ± 2.3, respectively (p = 0.613). The combined group presented with prolonged surgery duration(108.8 ± 28.0 and 186.1 ± 47.3 min, p = 0.028) and greater blood loss(276.3 ± 139.1 and 382.1 ± 283.1 ml, p<0.001). At short-term follow-up, the combined group presented a higher JOARR than the posterior group (posterior group: 50.7%±46.6%, combined group: 70.4%±20.3%, p = 0.024), while no significant difference in JOARR was observed between the groups at long-term follow-up (posterior group: 49.2%±48.5%, combined group: 59.6%±47.6%, p = 0.136). No significant difference was found in the overall complication and reoperation rates. CONCLUSIONS For MDCM patients with ISI, both posterior and one-stage posteroanterior approaches could achieve considerable neurological alleviations in short-term and long-term follow-up. With greater surgical trauma, the combined group presented better short-term JOARR but did not show higher efficacy in long-term neurological function preservation in patients with comparable preoperative conditions.
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Affiliation(s)
- Ruomu Qu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
- Peking University Health and Science Center, Beijing, China
| | - Ben Wang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Yiyuan Yang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Peking University Health and Science Center, Beijing, China
| | - Zexiang Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Peking University Health and Science Center, Beijing, China
| | - Zhuo Chen
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Peking University Health and Science Center, Beijing, China
| | - Yunxia Wu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Xiumao Li
- Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, PR China
| | - Liang Jiang
- Orthopaedic Department, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China.
| | - Xiaoguang Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Peking University, Beijing, China
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Partha Sarathi CI, Sinha A, Rafati Fard A, Bhatti F, Rujeedawa T, Ahmed S, Akhbari M, Bhatti A, Nouri A, Kotter MR, Davies BM, Mowforth OD. The significance of metabolic disease in degenerative cervical myelopathy: a systematic review. Front Neurol 2024; 15:1301003. [PMID: 38375465 PMCID: PMC10876002 DOI: 10.3389/fneur.2024.1301003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is a form of chronic spinal cord injury, with a natural history of potential for progression over time. Whilst driven by mechanical stress on the spinal cord from degenerative and congenital pathology, the neurological phenotype of DCM is likely to be modified by multiple systemic factors. The role of metabolic factors is therefore of interest, particularly given that ischaemia is considered a key pathological mechanism of spinal cord injury. The objective was therefore to synthesise current evidence on the effect of metabolism on DCM susceptibility, severity, and surgical outcomes. Methods A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English, with a focus on DCM and metabolism, including diabetes, cardiovascular disease, anaemia, and lipid profile, were eligible for inclusion. Risk of methodological bias was assessed using the Joanna Briggs Institute (JBI) critical assessment tools. Quality assessments were performed using the GRADE assessment tool. Patient demographics, metabolic factors and the relationships between metabolism and spinal cord disease, spinal column disease and post-operative outcomes were assessed. Results In total, 8,523 papers were identified, of which 57 met criteria for inclusion in the final analysis. A total of 91% (52/57) of included papers assessed the effects of diabetes in relation to DCM, of which 85% (44/52) reported an association with poor surgical outcomes; 42% of papers (24/57) discussed the association between cardiovascular health and DCM, of which 88% (21/24) reported a significant association. Overall, DCM patients with diabetes or cardiovascular disease experienced greater perioperative morbidity and poorer neurological recovery. They were also more likely to have comorbidities such as obesity and hyperlipidaemia. Conclusion Metabolic factors appear to be associated with surgical outcomes in DCM. However, evidence for a more specific role in DCM susceptibility and severity is uncertain. The pathophysiology and natural history of DCM are critical research priorities; the role of metabolism is therefore a key area for future research focus. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021268814.
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Affiliation(s)
- Celine Iswarya Partha Sarathi
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amil Sinha
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Amir Rafati Fard
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Faheem Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Tanzil Rujeedawa
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Shahzaib Ahmed
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Melika Akhbari
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aniqah Bhatti
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Mark R. Kotter
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M. Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Oliver D. Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom
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Wu Z, Zhang Z, Xu A, Lu S, Cui C, Sun B, Liu Y. Anterior direct decompression significantly relieves spinal cord high signal in patients with ossification of the posterior longitudinal ligament: a case-control study. J Orthop Surg Res 2023; 18:897. [PMID: 38001479 PMCID: PMC10675957 DOI: 10.1186/s13018-023-04388-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/18/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND In patients with cervical spondylotic myelopathy caused by ossification of the posterior longitudinal ligament, high cord signal (HCS) is frequently observed. However, limited research has investigated the variations in HCS improvement resulting from different surgical approaches. This study aims to explore the potential relationship between the choice of surgical approach and the postoperative improvement of intramedullary high signal in ossification of the posterior longitudinal ligament (OPLL) patients. METHODS We extensively reviewed the patients' medical records, based on which demographic information such as gender, age, and body mass index (BMI) were recorded, and assessed the severity of the patients' neurological status preoperatively and postoperatively by using the Japanese Orthopedic Association score (JOAs), focusing on consecutive preoperative and postoperative Magnetic resonance imaging (MRI) T2WI measurements, to study the statistical correlation between the improvement of HCS and the choice of surgical approach. RESULTS There were no significant differences in demographic, imaging parameters, and clinical symptoms between patients undergoing anterior and posterior surgery (p > 0.05, Table 1). However, both improvement in JOAs (Recovery2) and improvement in HCS (CR2) were significantly better in the anterior surgery group two years after surgery (p < 0.05, Table 1). Multifactorial logistic regression analysis revealed that posterior surgery and higher preoperative signal change ratio (SCR) were identified as risk factors for poor HCS improvement at the two-year postoperative period (p < 0.05, Table 2). Table 1 Differences in demographic, imaging parameters, and clinical symptoms in patients with anterior and posterior approach Anterior approach Posterior approach P-Values Demographic data Sex (male/female) 10/12 6/17 0.175 Age 58.59 ± 5.68 61.43 ± 9.04 0.215 Hypertension 14/8 14/9 0.848 Diabetes 16/6 19/4 0.425 BMI 25.58 ± 4.72 26.95 ± 4.58 0.331 Smoking history 19/3 16/7 0.175 Preoperative measured imaging parameters Preoperative SCR 1.615 ± 0.369 1.668 ± 0.356 0.623 CR1 0.106 ± 0.125 0.011 ± 0.246 0.08 CNR 0.33 ± 0.073 0.368 ± 0.096 0.15 C2-7 Cobb angle 8.977 ± 10.818 13.862 ± 13.191 0.182 SVA 15.212 ± 8.024 17.46 ± 8.91 0.38 mK-line INT 3.694 ± 3.291 4.527 ± 2.227 0.323 Imaging follow-up 6 months postoperative SCR 1.45 ± 0.44 1.63 ± 0.397 0.149 2 years postoperative SCR 1.26 ± 0.19 1.65 ± 0.35 0.000** CR2 0.219 ± 0.14 - 0.012 ± 0.237 0.000** Clinical symptoms Preoperative JOAs 10.64 ± 1.59 10.83 ± 1.47 0.679 6 months postoperative JOAs 11.82 ± 1.37 11.65 ± 1.4 0.69 2 years postoperative JOAs 14.18 ± 1.01 12.52 ± 2.06 0.001** Recovery1 0.181 ± 0.109 0.128 ± 0.154 0.189 Recovery2 0.536 ± 0.178 0.278 ± 0.307 0.001** *, statistical significance (p < 0.05). **, statistical significance (p < 0.01) BMI = body mass index. SCR = the signal change ratio between the localized high signal and normal spinal cord signal at the C7-T1 levels. CR1 = the regression of high cord signals at 6 months postoperatively (i.e., CR1 = (Preoperative SCR-SCR at 6 months postoperatively)/ Preoperative SCR). CR2 = the regression of high cord signal at 2 years postoperatively (i.e., CR2 = (Preoperative SCR-SCR at 2 years postoperatively)/ Preoperative SCR). CNR = canal narrowing ratio. SVA = sagittal vertical axis. mK-line INT = modified K-line interval. JOAs = Japanese Orthopedic Association score. Recovery1 = degree of JOAs recovery at 6 months postoperatively (i.e., Recover1 = (JOAs at 6 months postoperatively-Preoperative JOAs)/ (17- Preoperative JOAs)). Recovery2 = degree of JOAs recovery at 2 years postoperatively (i.e., Recover2 = (JOAs at 2 years postoperatively-Preoperative JOAs)/ (17-Preoperative JOAs)) Table 2 Linear regression analyses for lower CR2 values 95% CI P value Uni-variable analyses Demographic data Sex (male/female) - 0.01 0.221 0.924 Age - 0.015 0.003 0.195 Hypertension - 0.071 0.204 0.334 Diabetes - 0.195 0.135 0.716 BMI - 0.375 0.422 0.905 Smoking history - 0.249 0.077 0.295 Surgical approach - 0.349 - 0.113 0.000# Preoperative measured imaging parameters C2-7 Cobb angle - 0.009 0.002 0.185 SVA - 0.008 0.008 0.995 mK-line INT - 0.043 0.005 0.122 Preoperative SCR 0.092 0.445 0.004# CR1 0.156 0.784 0.004# CNR - 0.76 0.844 0.918 Multi-variable analyses Surgical approach - 0.321 - 0.118 0.000** Preoperative SCR 0.127 0.41 0.000** CR1 - 0.018 0.501 0.067 #, variables that achieved a significance level of p < 0.1 in the univariate analysis *statistical significance (p < 0.05). **statistical significance (p < 0.01) BMI = body mass index. SCR = the signal change ratio between the localized high signal and normal spinal cord signal at the C7-T1 levels. CR1 = the regression of high cord signals at 6 months postoperatively (i.e., CR1 = (Preoperative SCR-SCR at 6 months postoperatively)/ Preoperative SCR). CR2 = the regression of high cord signal at 2 years postoperatively (i.e., CR2 = (Preoperative SCR-SCR at 2 years postoperatively)/ Preoperative SCR). CNR = canal narrowing ratio. SVA = sagittal vertical axis. mK-line INT = modified K-line interval CONCLUSIONS: For patients with OPLL-induced cervical spondylotic myelopathy and intramedullary high signal, anterior removal of the ossified posterior longitudinal ligament and direct decompression offer a greater potential for regression of intramedullary high signal. At the same time, this anterior surgical strategy improves clinical neurologic function better than indirect decompression in the posterior approach.
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Affiliation(s)
- Zichuan Wu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Zifan Zhang
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Aochen Xu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Shihao Lu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Cheng Cui
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Baifeng Sun
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China
| | - Yang Liu
- Department of Spine Surgery, Shanghai Changzheng Hospital, Naval Medical University, 200003, Shanghai, People's Republic of China.
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Wang J, Li H, Yang B. Predictive Nomogram for Clinical Prognosis in Cervical Spondylotic Myelopathy With Intramedullary T2-Weighted Increased Signal Intensity: A Novel Digital Tool for Patient Prognosis Education. Front Public Health 2022; 10:898242. [PMID: 35712279 PMCID: PMC9194529 DOI: 10.3389/fpubh.2022.898242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/25/2022] [Indexed: 11/17/2022] Open
Abstract
Aims To establish a predictive nomogram for clinical prognosis in cervical spondylotic myelopathy (CSM) with intramedullary T2-weighted increased signal intensity (ISI). Methods The clinical data of 680 patients with CSM with intramedullary T2-weighted ISI were retrospectively analyzed. The patients were divided into the modeling group (476) and the validation group (204) by using a random number table at a ratio of 7:3. The independent prognostic factors were screened using multivariate logistic regression analysis. The factors were subsequently incorporated into the establishment of the predictive nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) was undertaken to estimate the discrimination of the predictive nomogram. The calibration curve and the Hosmer-Lemeshow test were used to assess the calibration of the predictive nomogram. The clinical usefulness of the predictive nomogram was evaluated by decision curve analysis (DCA). Results Based on the pre-operative Japanese Orthopedic Association (JOA) score, maximal canal compromise (MCC), and maximal spinal cord compression (MSCC), we established a predictive nomogram. The AUCs in the modeling group and validation group were 0.892 (95% CI: 0.861~0.924) and 0.885 (95% CI: 0.835~0.936), respectively, suggesting good discrimination of the nomogram. Calibration curves showed a favorable consistency between the predicted probability and the actual probability. In addition, the values of P of the Hosmer-Lemeshow were 0.253 and 0.184, respectively, suggesting good calibration of the nomogram. DCA demonstrated that the nomogram had good clinical usefulness. Conclusion We established and validated a predictive nomogram for the clinical prognosis in CSM with intramedullary T2-weighted ISI. This predictive nomogram could help clinicians and patients identify high-risk patients and educate them about prognosis, thereby improving the prognosis of high-risk patients.
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Affiliation(s)
- Jie Wang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Haopeng Li
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Baohui Yang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Tang B, Yao H, Wang S, Zhong Y, Cao K, Wan Z. In vivo 3-Dimensional Kinematics Study of the Healthy Cervical Spine Based on CBCT Combined with 3D-3D Registration Technology. Spine (Phila Pa 1976) 2021; 46:E1301-E1310. [PMID: 34593735 DOI: 10.1097/brs.0000000000004231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cervical biomechanical study. OBJECTIVE We sought to demonstrate the three-dimensional (3D) intervertebral motion characteristics of the cervical spine in healthy volunteers using cone beam computed tomography (CBCT) combined with 3D-3D registration technology. SUMMARY OF BACKGROUND DATA No previous studies have used CBCT combined with 3D-3D registration technology to successfully documented in vivo 3D intervertebral six-degrees-of-freedom (6-DOF) motions of the cervical spine. METHODS Twenty healthy subjects underwent cervical (C1-C7) CBCT scans in seven functional positions. Segmented 3D vertebral body models were established according to the cervical CBCT images. A 3D-to-3D registration was then performed for each vertebral body in the different positions to calculate the 3D segmental motion characteristics in vivo. RESULTS During flexion-extension, the range-of-motion (ROM) of C1-C2 and C4-C5 was significantly greater than the other segments. The average coupled axial rotation and lateral bending of each segment were between 0.6° and 3.2°. The average coupling translations in all directions were between 0.2 and 2.1 mm. During axial rotation, the ROM of C1-C2 was 65.8 ± 5.9°, which accounted for approximately 70% of all axial rotation. The motion and displacement of C1-C2 coupled lateral bending were 11.4 ± 5.2° and 8.3 ± 1.9 mm, respectively. During lateral bending, the ROM of C3-C4 was significantly greater than C1-C2, C5-C6, and C6-C7. The coupled axial rotation of C1-C2 was 34.4 ± 8.1°, and the coupled lateral translation was 3.8 ± 0.5 mm. The coupled superoinferior and anteroposterior translation of each cervical segment were between 0.1 and 0.6 mm. CONCLUSION CBCT combined with 3D-3D registration was used to accurately measure and record the ROMs of lateral bending, axial rotation, and flexion-extension in cervical vertebrae under physiological-load conditions. Our findings may contribute to the diagnosis of cervical spinal disease, the development of new surgical techniques, and the restoration of normal, cervical segmental movement.Level of Evidence: 3.
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Affiliation(s)
- Benyu Tang
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Haoqun Yao
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Shaobai Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Kinesiology, Shanghai University of Sport, Shanghai, P.R. China
| | - Yanlong Zhong
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Kai Cao
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
| | - Zongmiao Wan
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, P.R. China
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Partha Sarathi CI, Mowforth OD, Sinha A, Bhatti F, Bhatti A, Akhbari M, Ahmed S, Davies BM. The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review. Nutr Metab Insights 2021; 14:11786388211054664. [PMID: 34733105 PMCID: PMC8558601 DOI: 10.1177/11786388211054664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/03/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.
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Affiliation(s)
- Celine I Partha Sarathi
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Amil Sinha
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Faheem Bhatti
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Aniqah Bhatti
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Melika Akhbari
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Shahzaib Ahmed
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Elbhrawy S, Abdou A, ElSaghir H, Ashram YA, Mekky J. Pattern and Rate of Functional Recovery After Surgery for Cervical Spondylotic Myelopathy: Egyptian Prospective Study. World Neurosurg 2021; 150:e279-e286. [PMID: 33689851 DOI: 10.1016/j.wneu.2021.02.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study pattern and rate of neurological functional recovery after surgery for cervical spondylotic myelopathy (CSM). METHODS This prospective study comprised 25 patients with CSM who underwent surgical decompression at our institution. Upper limb, lower limb, and sphincter functions were assessed using the modified Japanese Orthopaedic Association score (mJOA). Assessment was done before the operation and at 1 month, 3 months, and 1 year after surgery. RESULTS The mJOA score did not significantly increase at 1 month after surgery (P = 0.051); however, increase in mJOA score was statistically significant at 3 and 1 year after surgery (P < 0.001 and P < 0.001, respectively). Upper limb motor dysfunction improved in 65% of patients, lower limb motor dysfunction improved in 52% of patients, upper limb sensory dysfunction improved in 48% of patients, and sphincter dysfunction improved in 14.2% of patients. There was a significant positive correlation between preoperative and postoperative mJOA score at 1 month, 3 months, and 1 year after surgery. CONCLUSIONS Minimal improvement occurred in the first month after CSM surgery to reach a peak at 3 months after surgery and steady improvement up to 1 year after surgery. Upper limbs recovered better and earlier than lower limbs and sphincter function. Preoperative severity of CSM is one of the main predictors of postoperative neurological outcome.
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Affiliation(s)
- Sonia Elbhrawy
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Ashraf Abdou
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hesham ElSaghir
- Spine Unit, Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmine A Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Jaidaa Mekky
- Department of Neurology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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10
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The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery. 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 2021; 30:1501-1508. [PMID: 33640994 DOI: 10.1007/s00586-021-06771-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/13/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Cervical focal kyphosis could often be observed in patients with cervical spondylotic myelopathy (CSM). However, the association between it and myelopathy severity remains unclear. This study aims to elucidate the association between cervical focal kyphosis and myelopathy severity before surgery. METHODS A retrospective review of 191 consecutive patients treated for CSM from 2017 to 2019 was surveyed. Seven MRI and five radiographic parameters were measured, clinical parameters were included. Patients were divided into two sagittal focal angle groups (lordosis/kyphosis) and two disc herniation severity groups (severe/non-severe). The potential risk factors of myelopathy symptoms were analysed. RESULTS Significant correlations between cervical sagittal focal angles, several other imaging findings and myelopathy severity were found in both total patients (R2 = 0.51, P < 0.001) and non-severe disc herniation patients (R2 = 0.73, P < 0.001) in multivariate regression models. Compression ratio of spinal cord exhibited the strongest correlation with JOA scores (r = - 0.567, P < 0.001). Cervical focal angles on MRI exhibited a stronger negative correlation with JOA scores (r = - 0.429, P < 0.001) than did angles on the other three postures on radiographs. Dramatic differences in JOA scores could be found in patients with non-severe cervical disc herniation, when a subgroup analysis was performed between cervical lordosis group and more than 4° kyphosis group (14.2 ± 1.7 vs. 11.1 ± 1.7, P < 0.001). CONCLUSION Cervical focal kyphosis associates with severe myelopathy symptoms in patients with CSM, especially without severe disc herniation. This association may indicate an optimal cervical focal angle in surgical plan. It appeared feasible to assess both the cervical focal angles and spinal cord compression on supine MRI.
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11
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Wang S, Ren Z, Liu J, Zhang J, Tian Y. The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients. BMC Neurol 2020; 20:221. [PMID: 32473653 PMCID: PMC7261380 DOI: 10.1186/s12883-020-01799-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. Methods A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. Results The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. Conclusions The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.
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Affiliation(s)
- Shujie Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China
| | - Zhifu Ren
- Department of Spine Surgery, Municipal Traditional Chinese Hospital, Weifang, Shandong, 261041, PR China
| | - Jia Liu
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China
| | - Ye Tian
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China.
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12
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Shabani S, Kaushal M, Budde M, Schmit B, Wang MC, Kurpad S. Comparison between quantitative measurements of diffusion tensor imaging and T2 signal intensity in a large series of cervical spondylotic myelopathy patients for assessment of disease severity and prognostication of recovery. J Neurosurg Spine 2019; 31:473-479. [PMID: 31174184 DOI: 10.3171/2019.3.spine181328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction. Recently, it has been shown that diffusion tensor imaging (DTI) may be a better biomarker than T2-weighted signal intensity (T2SI) on MRI for CSM. However, there is very little literature on a comparison between the quantitative measurements of DTI and T2SI in the CSM patient population to determine disease severity and recovery. METHODS A prospective analysis of 46 patients with both preoperative DTI and T2-weighted MRI was undertaken. Normalized T2SI (NT2SI), regardless of the presence or absence of T2SI at the level of maximum compression (LMC), was determined by calculating the T2SI at the LMC/T2SI at the level of the foramen magnum. Regression analysis was performed to determine the relationship of fractional anisotropy (FA), a quantitative measure derived from DTI, and NT2SI individually as well their combination with baseline preoperative modified Japanese Orthopaedic Association (mJOA) score and ∆mJOA score at the 3-, 6-, 12-, and 24-month follow-ups. Goodness-of-fit analysis was done using residual diagnostics. In addition, mixed-effects regression analysis was used to evaluate the impact of FA and NT2SI individually. A p value < 0.05 was selected to indicate statistical significance. RESULTS Regression analysis showed a significant positive correlation between FA at the LMC and preoperative mJOA score (p = 0.041) but a significant negative correlation between FA at the LMC and the ΔmJOA score at the 12-month follow-up (p = 0.010). All other relationships between FA at the LMC and the baseline preoperative mJOA score or ∆mJOA score at the 3-, 6-, and 24-month follow-ups were not statistically significant. For NT2SI and the combination of FA and NT2SI, no significant relationships with preoperative mJOA score or ∆mJOA at 3, 6, and 24 months were seen on regression analysis. However, there was a significant correlation of combined FA and NT2SI with ∆mJOA score at the 12-month follow-up. Mixed-effects regression revealed that FA measured at the LMC was the only significant predictor of ΔmJOA score (p = 0.03), whereas NT2SI and time were not. Goodness-of-fit analysis did not show any evidence of lack of fit. CONCLUSIONS In this large prospective study of CSM patients, FA at LMC appears to be a better biomarker for determining long-term outcomes following surgery in CSM patients than NT2SI or the combination values at LMC.
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Affiliation(s)
- Saman Shabani
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Mayank Kaushal
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Matthew Budde
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Brian Schmit
- 2Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Marjorie C Wang
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Shekar Kurpad
- 1Department of Neurosurgery, Medical College of Wisconsin; and
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13
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Zileli M, Borkar SA, Sinha S, Reinas R, Alves ÓL, Kim SH, Pawar S, Murali B, Parthiban J. Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques -WFNS Spine Committee Recommendations. Neurospine 2019; 16:386-402. [PMID: 31607071 PMCID: PMC6790728 DOI: 10.14245/ns.1938240.120] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
Objective This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques.
Methods A literature search was performed for articles published during the last 10 years.
Results The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease.
Conclusion The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Sachin A Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Sinha
- Neurosurgery and Spine Services, Paras Hospitals, Gurugram, India
| | - Rui Reinas
- Neurosurgical Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Hospital Lusíadas, Porto, Portugal
| | - Óscar L Alves
- Department of Neurosurgery, Hospital Lusíadas, Porto, Portugal
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University Medical Center, Seoul, Korea
| | | | - Bala Murali
- Kauvery Advanced Spine Centre, Chennai, India
| | - Jutty Parthiban
- Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Tamilnadu, India
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14
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Wei L, Cao P, Xu C, Wu H, Hua D, Tian Y, Yuan W. Comparison of Three Anterior Techniques in the Surgical Treatment of Three-Level Cervical Spondylotic Myelopathy with Intramedullary T2-Weighted Increased Signal Intensity. World Neurosurg 2019; 126:e842-e852. [DOI: 10.1016/j.wneu.2019.02.182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
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15
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Does three-grade classification of T2-weighted increased signal intensity reflect the severity of myelopathy and surgical outcomes in patients with cervical compressive myelopathy? A systematic review and meta-analysis. Neurosurg Rev 2019; 43:967-976. [PMID: 31053986 DOI: 10.1007/s10143-019-01106-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/15/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
The three-grade classification of increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) is used extensively in patients with cervical compressive myelopathy (CCM). However, the efficacy and value in the prediction of this classification are still unclear and no systematic review and meta-analysis have been conducted on this topic. The objective of this study is to investigate the efficacy and value in prediction of the three-grade classification of ISI on the severity of myelopathy and surgical outcomes. Randomized or non-randomized controlled studies using three-grade classification of ISI (grade 0, none; grade 1, light or obscure; and grade 2, intense or bright) in patients with CCM were sought in the following databases: PubMed, Embase, and Cochrane Library. The pooled Japanese Orthopedic Association (JOA)/modified JOA (mJOA) score, neuro-functional recovery rate, C2-C7 lordotic angle, and range of motion (ROM) were calculated. A total of 8 studies containing 1101 patients were included in this review. Patients in grade 0 had the highest preoperative and postoperative JOA/mJOA score and recovery rate, while those parameters for patients in grade 2 were the lowest. Nevertheless, no statistically significant difference was found regarding the preoperative C2-C7 lordotic angle and ROM among three grades. Our meta-analysis suggests that the three-grade classification of ISI on T2-weighted MRI can reflect the severity of myelopathy and surgical outcomes in patients with CCM. The higher ISI grade indicates more severe myelopathy and surgical outcomes. Overall, the three-grade classification of ISI is instructive and should be used universally.
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16
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Shen C, Xu H, Xu B, Zhang X, Li X, Yang Q, Ma X. Value of conventional MRI and diffusion tensor imaging parameters in predicting surgical outcome in patients with degenerative cervical myelopathy. J Back Musculoskelet Rehabil 2018; 31:525-532. [PMID: 29332032 DOI: 10.3233/bmr-170972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND In addition to conventional magnetic resonance imaging (cMRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and prognostic tool for patients with degenerative cervical myelopathy (DCM). OBJECTIVE To assess the efficacy of cMRI and DTI parameters in prediction of surgical outcome in DCM patients. METHODS One hundred and forty-two patients with DCM who underwent presurgical cMRI and DTI of the cervical spine were included. Quantitative parameters obtained by cMRI included compression ratio (CR), transverse area (TA), and signal intensity ratio (SIR). DTI was evaluated for apparent diffusion coefficient (ADC) and fractional anisotropy (FA). The Japanese Orthopaedic Association (JOA) score and recovery rate were used to evaluate clinical outcomes. A JOA recovery rate < 50% was defined as a poor surgical outcome. The relationship of surgical outcome with various imaging parameters was examined. Receiver operating characteristic (ROC) curves were used to measure the predictive ability and determine the best cut-off values of the quantitative parameters. RESULTS By ROC curve analyses of imaging parameters, the largest area under the ROC curve (AUC) was for FA (0.750), followed by ADC (0.719), TA (0.716), SIR (0.673), and CR (0.591). The cut-off values with the best compromise between sensitivity and specificity were set at 0.390 for FA, 1.344 × 10-3 mm2/s for ADC, 46.02 mm2 for TA, 1.556 for SIR, and 26.56% for CR. Multivariate logistic regression model revealed that JOA score ⩽ 8 points, TA ⩽ 46.02 mm2, and FA ⩽ 0.390 were independently associated with poor surgical outcome. The AUC value for the three-predictor model was 0.871, indicating strong predictive discrimination, and was significantly higher than the AUC value for the model containing only the JOA score (0.763; P= 0.003). CONCLUSIONS JOA score is a reasonable predictor of surgical outcome in DCM. However, a model inclusive of TA and FA provides superior predictive ability. Thus, quantitative analysis of cMRI and DTI is useful for predicting surgical outcome in DCM.
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Affiliation(s)
| | - Haiwei Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Baoshan Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | | | - Xiaofeng Li
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Xinlong Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin, China
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Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity. World Neurosurg 2018; 112:e520-e526. [DOI: 10.1016/j.wneu.2018.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/20/2022]
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18
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Rao A, Soliman H, Kaushal M, Motovylyak O, Vedantam A, Budde MD, Schmit B, Wang M, Kurpad SN. Diffusion Tensor Imaging in a Large Longitudinal Series of Patients With Cervical Spondylotic Myelopathy Correlated With Long-Term Functional Outcome. Neurosurgery 2018. [DOI: 10.1093/neuros/nyx558] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Fractional anisotropy (FA) of the high cervical cord correlates with upper limb function in acute cervical cord injury. We investigated the correlation between preoperative FA at the level of maximal compression and functional recovery in a group of patients after decompressive surgery for cervical spondylotic myelopathy (CSM).
OBJECTIVE
To determine the usefulness of FA as a biomarker for severity of CSM and as a prognostic biomarker for improvement after surgery.
METHODS
Patients received diffusion tensor imaging (DTI) scans preoperatively. FA values of the whole cord cross-section at the level of maximal compression and upper cervical cord (C1-2) were calculated. Functional status was measured using the modified Japanese Orthopedic Association (mJOA) scale preoperatively and at follow-up up to 2 yr. Regression analysis between FA and mJOA was performed. DTI at C4-7 was obtained in controls.
RESULTS
Forty-four CSM patients enrolled prior to decompression were compared with 24 controls. FA at the level of maximal compression correlated positively with preoperative mJOA score. Preoperative FA correlated inversely with recovery throughout the postoperative period. This was statistically significant at 12 mo postoperation and nearly so at 6 and 24 mo. Patients with preoperative FA <0.55 had a statistically significant difference in outcome compared to FA >0.55.
CONCLUSION
In the largest longitudinal study of this kind, FA promises a valid biomarker for severity of CSM and postoperative improvement. FA is an objective measure of function and could provide a basis for prognosis. FA is particularly useful if preoperative values are less than 0.55.
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Affiliation(s)
- Avinash Rao
- University of Wisconsin School of Medi-cine and Public Health, Madison, Wisconsin
| | - Hesham Soliman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mayank Kaushal
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Olesya Motovylyak
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Aditya Vedantam
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Matthew D Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Schmit
- Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Marjorie Wang
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Zhong H, Zhou Z, Liu J, Guo L, Lv GH, Li J, Zou MX. Letter: Clinical Outcomes Following Surgical Management of Coexisting Parkinson Disease and Cervical Spondylotic Myelopathy. Neurosurgery 2018; 82:E65-E66. [PMID: 29053829 DOI: 10.1093/neuros/nyx540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hua Zhong
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Zhihong Zhou
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Jianchun Liu
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Lebin Guo
- Department of Orthopedics Surgery Central Hospital of Yi Yang Yiyang, China
| | - Guo-Hua Lv
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Jing Li
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
| | - Ming-Xiang Zou
- Department of Spine Surgery The Second Xiangya Hospital Central South University Changsha, China
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Tetreault L, Palubiski LM, Kryshtalskyj M, Idler RK, Martin AR, Ganau M, Wilson JR, Kotter M, Fehlings MG. Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:115-127.e35. [DOI: 10.1016/j.nec.2017.09.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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21
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The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy: Analysis of a Global Cohort. Spine (Phila Pa 1976) 2017; 42:1851-1858. [PMID: 28498290 DOI: 10.1097/brs.0000000000002234] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospective data. OBJECTIVE To assess the relationship between MRI signal intensity changes, clinical presentation, and surgical outcome in degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Several studies have sought to assess the extent of spinal cord dysfunction and the potential for postoperative neurological recovery through the evaluation of spinal cord signal change on T2-weighted (T2WI) and T1-weighted images (T1WI). There remains ambiguity if T2WI and T1WI signal changes (1) relate to baseline severity, and (2) predict neurological recovery after surgical treatment. METHODS Four hundred nineteen MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of spinal cord signal intensity changes and compared with clinical data. Signal changes were also evaluated for the prediction of 2-year postoperative outcome using mJOA parameters. RESULTS MRIs were categorized by T1WI and T2WI signal change: no signal change (28.9%), T2WI hyperintensity-only (T2WI-only, 51.8%), and T2WI-hyperintensity and T1WI-hypointensity (T1WI+T2WI, 19.3%). T2WI-hyperintensity was present at multiple levels in 27% of patients overall. Baseline severity increased from no signal change to T2WI-only to T2WI+T1WI (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. There were no differences in outcomes between no signal change and T2WI-only groups. The presence of T1WI-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005), adjusting for baseline mJOA. A greater number of T2WI-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001). CONCLUSION This analysis of a global cohort of DCM patients shows a stepwise trend toward increasing impairment from no signal change to T2WI-hypertensity to T1WI-hypointensity. T1WI signal change indicates more permanent injury, portending decreased functional recovery. T2WI-hyperintensity alone does not predict outcomes. Multiple levels of T2WI-hyperintensity suggest additional tissue injury, correlating with worse clinical impairment and recovery potential. LEVEL OF EVIDENCE 2.
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Lin X, Li C, Lin Q, Zheng Z. Intraoperative neuromonitoring loss in abnormal magnetic resonance imaging signal intensity from patients with cervical compressive myelopathy. J Neurol Sci 2017; 381:235-239. [PMID: 28991689 DOI: 10.1016/j.jns.2017.08.3261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Our objective of this study was to evaluate if cervical compressive myelopathy (CCM) patients with preoperative abnormal magnetic resonance imaging (MRI) might easily lead to intraoperative neuromonitoring (IONM) loss. METHOD A consecutive series of 152 CCM patients who underwent cervical cord decompression were enrolled in this study between December 2013 and February 2017. All patients with abnormal MRI signal intensity were divided into 2 groups (group 1: T2-WIs hyperintensity; group 2: both T2-WIs hyperintensity and T1-WIs hypointensity). Relevant IONM changes were identified as significant transcranial motor evoked potentials (MEP) loss associated with surgical decompression of cervical cord. RESULTS There were 121 patients in group 1, and then 6 cases showed IONM degeneration; 31 patients in group 2, and then 13 cases showed IONM degeneration (6/121 versus 13/31, p=0.000). Moreover, one case presented transient new spinal deficits after surgery, no permanent spinal deficit in group 1; 5 cases presented transient new spinal deficits, 2 cases showed permanent spinal deficit in group 2. And in group 2 the MEP amplitude before and after decompression had significant difference (134μV±30.2 versus 65μV±26.2, *p<0.05). CONCLUSION Our results suggest that the IONM degenerations or postoperative spinal deficits are more likely to appear on patients with abnormal T2-WIs and T1-WIs. Appropriate and timely interventions are probably useful for IONM recovery.
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Affiliation(s)
- Xiangquan Lin
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Chaoxiong Li
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Qin Lin
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Zhong Zheng
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China.
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Diffusion tensor imaging can predict surgical outcomes of patients with cervical compression myelopathy. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017. [DOI: 10.1007/s00586-017-5191-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Bhalla A, Rolfe KW. Inadequate Surgical Decompression in Patients with Cervical Myelopathy: A Retrospective Review. Global Spine J 2016; 6:542-7. [PMID: 27555995 PMCID: PMC4993611 DOI: 10.1055/s-0035-1569463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 09/24/2015] [Indexed: 11/26/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE We reviewed cases of surgically treated cervical spondylotic myelopathy (CSM) or chronic, degenerative myelopathy of the subaxial cervical spine to study the incidence of inadequate surgical decompression. METHODS We included all persons treated at our institution after a first surgical decompression for CSM over a 3-year period. Inadequate original surgical decompression was defined as neurologic decline within 12 months postoperatively and ongoing impingement of the spinal cord with <1-mm change in anteroposterior canal dimension from pre- to postoperative magnetic resonance imaging (MRI) leading to revision decompressive surgery. Revisions for other reasons were not counted as inadequate. RESULTS Of 50 patients, 5 (10%) required revision decompression for neurologic decline and inadequate change in space available for the cord on postoperative imaging; 4 patients declined within the first 6 months and 1 patient at 8 months postoperatively. None of the 5 declined further after posterior revision, but none recovered from the interval loss. All 5 had undergone anterior approaches, for an anterior inadequacy rate of 23% (5 of 22). None of the 28 patients having posterior or combined approach declined at 2 years or had <1-mm change on postoperative MRI. The difference between anterior and posterior approaches was statistically significant (p = 0.018). CONCLUSIONS The rate of inadequate surgical decompression for CSM was greater than expected in this series and directly associated with an anterior approach. No cases of inadequacy occurred for posterior or combined approaches. Postoperative neuroradiographic imaging such as MRI should be entertained routinely for this entity or at least for anterior-only approaches.
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Affiliation(s)
- Amandeep Bhalla
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, California, United States,Address for correspondence Kevin W. Rolfe, MD Department of Neurological and Orthopedic SurgeryRancho Los Amigos National Rehabilitation Center7601 E. Imperial Highway, Downey, CA 90242United States
| | - Kevin W. Rolfe
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, California, United States,Department of Neurological and Orthopedic Surgery, Rancho Los Amigos National Rehabilitation Center, Downey, California
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