In Reply to the Letter to the Editor regarding "An Evidence-Based Stepwise Surgical Approach to Cervical Spondylotic Myelopathy: A Narrative Review of the Current Literature"

Beneficial Effect of Repetitive Transcranial Magnetic Stimulation Combined With Physiotherapy After Cervical Spondylotic Myelopathy Surgery

PURPOSE

Cervical spondylotic myelopathy (CSM) is one of the most notable causes of spinal cord impairment among elderly people worldwide. Little is written about the influence of postoperative rehabilitation on recovery of function in patients with CSM. In this study, we assessed the combined effects of repetitive transcranial magnetic stimulation (rTMS) combined with physiotherapy and physiotherapy alone on motor and sensory improvement assessed after spinal cord decompression in patients with CSM.

METHODS

This prospective study comprised 52 patients with CSM; they were divided into two randomized groups after spinal cord decompression. The first group (group Ι) includes 26 patients, received a combination of rTMS and physiotherapy. The second group (group ΙΙ) of 26 patients underwent only physiotherapy. The neurologic assessment measures, including American Spinal Cord Injury Association score, modified Japanese Orthopaedic Association score, Ashworth scale, and Nurick grade, were recorded before and after rehabilitation interventions for each patient.

RESULTS

According to the neurologic assessment measures, physiotherapy with/without rTMS after surgical decompression corresponded to significant improvement of motor function ( P < 0. 01) without significant restoration of sensory function ( P > 0. 01). Recovery rates of motor function were significantly better in group Ι than in group ΙΙ ( P < 0. 01). There was no significant difference between two groups with respect to age ( P = 0.162) and sex ( P = 1.00).

CONCLUSIONS

Although physiotherapy with/without rTMS improves motor function recovery after CSM surgery, rTMS in combination with physiotherapy leads to a more rapid motor function recovery than physiotherapy alone.

Unilateral lag screw fixation of isolated non-union atlas lateral mass fracture: a new technical note

We describe a novel and new technique of posterior unilateral lag screw fixation of non-union atlas lateral mass fracture. A 46-year-old man presented with cervical pain and tenderness after a vehicle turn over accident and he was diagnosed to have left atlas lateral mass fracture. He was initially treated by immobilization using Minerva orthosis. About 2 months later, he developed severe neck pain and limitation of motion and thus he was scheduled for operation due to non-union atlas lateral mass fracture. A 28 mm lag screw was inserted under anterior-posterior and lateral fluoroscopic views. The entrance point was at the dorsal aspect of left atlas posterior arc at its junction to the lateral mass, and by using the trajectory of 10 degrees medial and 22 degrees cephalad fracture reduction was achieved. Unilateral lag screw fixation of atlas fractures is an appropriate, safe and effective surgical technique for the management of unilateral atlas fractures.

Clinical and radiological outcomes after decompression and posterior fusion in patients with degenerative scoliosis

OBJECTIVE

The prevalence of degenerative scoliosis (DS) increases with age and an overall increase is seen due to the aging population. This study aims to evaluate the clinical and radiological outcomes after decompression and posterior fusion in patients with DS.

METHODS

In this is prospective study, 43 patients with DS, aged 37 to 70 years, were eligible to undergo decompression and posterior fusion. Primary outcomes were low back pain (LBP) with or without radicular pain, which was evaluated preoperatively and at 12 and 24 months after surgery with the use of a visual analog scale (VAS), and the quality of life (QOL), which was assessed at the same time periods by the Oswestry Disability Index (ODI) questionnaire. The Cobb's method was used to measure the degree of scoliosis in each patient preoperatively and at 24 hours, 12 and 24 months after the surgery.

RESULTS

VAS scores improved significantly from a mean of 8.18 preoperatively to 4.48 at 12 months and 3.07 at 24 months postoperatively (P < .001). The mean radicular pain scores also decreased significantly (P < .001). At postoperative 12 months, the mean ODI score was significantly lower than the mean preoperative ODI score (47.81 ± 16.06 vs. 72.18 ± 12.28; P = .001). ODI score at 24 months postoperatively was significantly better than the preoperative ODI (15.53 ± 7.21 vs. 72.18 ± 12.28; P = .016). The mean Cobb angle changed significantly from 31.4° ± 4.88 preoperatively to 3.28° ± 2.10 at 24 months postoperatively (P < .001).

CONCLUSIONS

Our findings suggest that decompression and posterior fusion in the patients with DS is an effective surgical method which is associated with satisfying clinical results in terms of improvement of postoperative LBP, radicular pain, and QOL, and correction of Cobb angle at 12 and 24 months after the surgery and restoration of sagittal alignment at 2 months postoperatively.