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Garzón M, Balasch-Bernat M, Cook C, Ezzatvar Y, Álvarez-Lliso Ó, Dueñas L, Lluch E. How long does tendinopathy last if left untreated? Natural history of the main tendinopathies affecting the upper and lower limb: A systematic review and meta-analysis of randomized controlled trials. Musculoskelet Sci Pract 2024; 72:103103. [PMID: 38879981 DOI: 10.1016/j.msksp.2024.103103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Natural history of disease refers to the progression of a disease process in an individual over time, in the absence of treatment. Understanding natural history of tendinopathies is key for clinicians to make accurate prognostic predictions and design effective intervention studies. OBJECTIVE To quantify the natural history of the main tendinopathies regarding pain and function and to compare outcomes between untreated individuals and those receiving treatment. METHODS A systematic literature search was conducted until February 2023, across PubMed, Cochrane, Embase and Scopus databases. Selection criteria included randomized controlled trials (RCTs) with a "wait-and-see" group and cohort studies with ≥3 months of follow-up reporting on pain and function-related outcomes. Standardized mean differences (SMDs) of "wait-and-see" groups were pooled using a random-effects inverse-variance model. Risk of bias was assessed using Cochrane Risk-of-Bias (RoB2), and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. RESULTS Six RCTs were included, encompassing 518 subjects with tendinopathy. Pooled results demonstrated significant pain (SMD = 0.30, 95%CI: 0.19-0.41) and physical function improvement (SMD = 0.38, 95%CI: 0.28-0.48). These estimates remained consistent regardless of age or follow-up duration. In rotator cuff tendinopathy, untreated individuals improved but did not fully recover at one year, with similar outcomes to other interventions (e.g., surgery). Subjects with lateral elbow, patellar and achilles tendinopathies when untreated, did not fully resolve symptoms within 12-16 weeks. CONCLUSIONS This review provides limited conclusions about natural history of tendinopathies. Future studies should incorporate true no-intervention groups to accurately reflect tendinopathy's natural progression.
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Affiliation(s)
- M Garzón
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - M Balasch-Bernat
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - C Cook
- Division of Physical Therapy, Department of Orthopaedics, Department of Population Health Sciences, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA.
| | - Y Ezzatvar
- Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46010, Valencia, Spain.
| | - Ó Álvarez-Lliso
- Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - L Dueñas
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain.
| | - E Lluch
- Physiotherapy in Motion, Multi Speciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain; Departments of Human Physiology and Rehabilitation Sciences, "Pain in Motion" International Research Group, Brussels, Belgium.
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Yang Y, Wang F. Hidden blood loss in unilateral open-door cervical laminoplasty for multilevel cervical spondylotic myelopathy. Jt Dis Relat Surg 2024; 35:293-298. [PMID: 38727107 PMCID: PMC11128948 DOI: 10.52312/jdrs.2024.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/22/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the hidden blood loss (HBL) and its possible risk factors after unilateral open-door cervical laminoplasty (UOCL) in patients with multilevel cervical spondylotic myelopathy (MCSM). PATIENTS AND METHODS Between January 2018 and March 2023, a total of 105 patients (55 males, 50 females; median age: 76 years; range, 52 to 93 years) who underwent C3-7 UOCL for MCSM were retrospectively analyzed. Data of the patients were recorded, including age, sex, height, weight, plasma albumin, blood glucose, hematocrit, American Society of Anesthesiologists (ASA) score, surgical time, and intraoperative blood loss. The HBL was calculated according to the Sehat formula, and risk factors were identified. RESULTS The median surgical time was 180.7 min. The median total blood loss (TBL) and median HBL were 507.4 mL and 201.7 mL, respectively. Correlation analyses revealed that body mass index and surgical time were correlated with HBL (p<0.05). However, multiple linear regression analysis showed that HBL was positively correlated with surgical time (β=0.293, p<0.05). CONCLUSION Our study results showed that surgical time is an independent risk factor for HBL. Therefore, HBL should not be overlooked in patients with MCSM undergoing UOCL, particularly in the patients with expected long surgical time.
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Affiliation(s)
- Yun Yang
- Department of Orthopaedics, The Third People's Hospital of Chengdu, 610000 Chengdu, China.
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Shool S, Rahmani S, Habibi MA, Piri SM, Lotfinia M, Jashnani D, Asaadi S. Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review. Spinal Cord Ser Cases 2024; 10:21. [PMID: 38615029 PMCID: PMC11016077 DOI: 10.1038/s41394-024-00636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Scoping systematic review. OBJECTIVES To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models. SETTING Tehran, Iran. METHODS In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models. RESULTS A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures. CONCLUSIONS The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
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Affiliation(s)
- Sina Shool
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Saeed Rahmani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Mahmoud Lotfinia
- Resident of Neurosurgery, Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Germany
| | - Delara Jashnani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Department of Surgery, Division of Acute Care Surgery, Loma Linda University, Loma Linda, CA, USA.
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Matsoukas S, Zipser CM, Zipser-Mohammadzada F, Kheram N, Boraschi A, Jiang Z, Tetreault L, Fehlings MG, Davies BM, Margetis K. Scoping Review with Topic Modeling on the Diagnostic Criteria for Degenerative Cervical Myelopathy. Global Spine J 2024:21925682241237469. [PMID: 38442295 DOI: 10.1177/21925682241237469] [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] [Indexed: 03/07/2024] Open
Abstract
STUDY DESIGN This study is a scoping review. OBJECTIVE There is a broad variability in the definition of degenerative cervical myelopathy (DCM) and no standardized set of diagnostic criteria to date. METHODS We interrogated the Myelopathy.org database, a hand-indexed database of primary clinical studies conducted exclusively on DCM in humans between 2005-2021. The DCM inclusion criteria used in these studies were inputted into 3 topic modeling algorithms: Hierarchical Dirichlet Process (HDP), Latent Dirichlet Allocation (LDA), and BERtopic. The emerging topics were subjected to manual labeling and interpretation. RESULTS Of 1676 reports, 120 papers (7.16%) had well-defined inclusion criteria and were subjected to topic modeling. Four topics emerged from the HDP model: disturbance from extremity weakness and motor signs; fine-motor and sensory disturbance of upper extremity; a combination of imaging and clinical findings is required for the diagnosis; and "reinforcing" (or modifying) factors that can aid in the diagnosis in borderline cases. The LDA model showed the following topics: disturbance to the patient is required for the diagnosis; reinforcing factors can aid in the diagnosis in borderline cases; clinical findings from the extremities; and a combination of imaging and clinical findings is required for the diagnosis. BERTopic identified the following topics: imaging abnormality, typical clinical features, range of objective criteria, and presence of clinical findings. CONCLUSIONS This review provides quantifiable data that only a minority of past studies in DCM provided meaningful inclusion criteria. The items and patterns found here are very useful for the development of diagnostic criteria for DCM.
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Affiliation(s)
- Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Zhilin Jiang
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lindsay Tetreault
- Department of Neurology, Langone Health, Graduate Medical Education, New York University, New York, NY, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Benjamin M Davies
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Khosravi S, Farahbakhsh F, Hesari M, Shahmohammadi A, Aliakbargolkar A, Baigi V, Eskandari Z, Ghodsi Z, Harrop J, Rahimi-Movaghar V, Ghodsi SM. Predictors of Outcome After Surgical Decompression for mild degenerative Cervical Myelopathy -A Systematic Review. Global Spine J 2024; 14:697-706. [PMID: 36912895 PMCID: PMC10802523 DOI: 10.1177/21925682231164346] [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] [Indexed: 03/14/2023] Open
Abstract
STUDY DESIGN Systematic Reviews. OBJECTIVES To investigate predictors of surgical outcomes for mild Degenerative Cervical Myelopathy (DCM) by reviewing all related studies conducted at this point. METHODS An electronic search was carried out in PubMed, EMBASE, Scopus, and Web of Science until June 23, 2021. Full-text articles reporting surgical outcome predictors of mild DCM cases were eligible. We included studies with mild DCM which was defined as a modified Japanese Orthopaedic Association score of 15 to 17 or a Japanese Orthopaedic Association score of 13 to 16. Independent reviewers screened all the records, and discrepancies between the reviewers were solved in a session with the senior author. For risk of bias assessment, RoB 2 tool was used for randomized clinical trials and ROBINS-I for non-randomized studies. RESULTS After screening 6 087 manuscripts, only 8 studies met the inclusion criteria. Lower pre-operative mJOA scores and quality-of-life measurement scores were reported by multiple studies to predict better surgical outcomes compared to other groups. High-intensity pre-operative T2 magnetic resonance imaging (MRI) was also reported to predict poor outcomes. Neck pain before intervention resulted in improved patient-reported outcomes. Two studies also reported motor symptoms prior to surgery as outcome predictors. CONCLUSION Lower quality of life before surgery, neck pain, lower pre-operative mJOA scores, motor symptoms before surgery, female gender, gastrointestinal comorbidities, surgical procedure and surgeon's experience with specific techniques, and high signal intensity of cord in T2 MRI were the surgical outcome predictors reported in the literature. Lower Quality of Life (QoL) score and neck prior to surgery were reported as predictors of the more improved outcome, but high cord signal intensity in T2 MRI was reported as an unfavorable outcome predictor.
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Affiliation(s)
- Sepehr Khosravi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Farahbakhsh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Alireza Aliakbargolkar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Eskandari
- Department of Management, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - James Harrop
- Department of Neurological and Orthopedic Surgery Chief, Division of Spine and Peripheral Nerve Surgery Director, Enterprise Neuroscience Quality and Safety Neurosurgery Director of Delaware Valley SCI Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
- Visiting Professor, Spine Program, University of Toronto, Toronto, Canada
| | - Seyed Mohammad Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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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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Malhotra AK, Shakil H, Harrington EM, Fehlings MG, Wilson JR, Witiw CD. Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis. Spine J 2024; 24:21-31. [PMID: 37302415 DOI: 10.1016/j.spinee.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/10/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is a form of acquired spinal cord compression and contributes to reduced quality of life secondary to neurological dysfunction and pain. There remains uncertainty regarding optimal management for individuals with mild myelopathy. Specifically, owing to lacking long-term natural history studies in this population, we do not know whether these individuals should be treated with initial surgery or observation. PURPOSE We sought to perform a cost-utility analysis to examine early surgery for mild degenerative cervical myelopathy from the healthcare payer perspective. STUDY DESIGN/SETTING We utilized data from the prospective observational cohorts included in the Cervical Spondylotic Myelopathy AO Spine International and North America studies to determine health related quality of life estimates and clinical myelopathy outcomes. PATIENT SAMPLE We recruited all patients that underwent surgery for DCM enrolled in the Cervical Spondylotic Myelopathy AO Spine International and North America studies between December 2005 and January 2011. OUTCOME MEASURES Clinical assessment measures were obtained using the Modified Japanese Orthopedic Association scale and health-related quality of life measures were obtained using the Short Form-6D utility score at baseline (preoperative), 6 months, 12 months and 24 months postsurgery. Cost measures inflated to January 2015 values were obtained using pooled estimates from the hospital payer perspective for surgical patients. METHODS We employed a Markov state transition model with Monte Carlo microsimulation using a lifetime horizon to obtain an incremental cost utility ratio associated with early surgery for mild myelopathy. Parameter uncertainty was assessed through deterministic means using one-way and two-way sensitivity analyses and probabilistically using parameter estimate distributions with microsimulation (10,000 trials). Costs and utilities were discounted at 3% per annum. RESULTS Initial surgery for mild degenerative cervical myelopathy was associated with an incremental lifetime increase of 1.26 quality-adjusted life years (QALY) compared to observation. The associated cost incurred to the healthcare payer over a lifetime horizon was $12,894.56, resulting in a lifetime incremental cost-utility ratio of $10,250.71/QALY. Utilizing a willingness to pay threshold in keeping with the World Health Organization definition of "very cost-effective" ($54,000 CDN), the probabilistic sensitivity analysis demonstrated that 100% of cases were cost-effective. CONCLUSIONS Surgery compared to initial observation for mild degenerative cervical myelopathy was cost-effective from the Canadian healthcare payer perspective and was associated with lifetime gains in health-related quality of life.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Husain Shakil
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Erin M Harrington
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Krembil Research Institute, Toronto Western Hospital, 60 Leonard Ave, Toronto, Ontario, M5T 0S8, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada.
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Sarraj M, Hache P, Foroutan F, Oitment C, Marion TE, Guha D, Pahuta M. Natural history of degenerative cervical myelopathy: a meta-analysis and neurologic deterioration survival curve synthesis. Spine J 2024; 24:46-56. [PMID: 37549831 DOI: 10.1016/j.spinee.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND CONTEXT Cervical spine surgery is rapidly increasing, and our knowledge of the natural history of degenerative cervical myelopathy (DCM) is limited. PURPOSE To synthesize accurate time-based estimates of meaningful neurologic decline in patients with DCM managed conservatively and to provide formulae to help communicate survivorship estimates to patients. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review and meta-analysis was conducted using Cochrane and PRISMA guidelines. A librarian-assisted search strategy using multiple databases with broad search terms and validated filter functions was used. All articles were reviewed in duplicate. RESULTS A total of 9570 studies were captured in the initial search, which after deletion of duplicates and manual review of abstracts and full texts revealed 6 studies for analyses. All studies were prospective cohorts or randomized controlled trials. The pooled survival estimates for neurologic stability (95% CrI) for mild DCM patients are: 91% (83%-97%) at one year; 85% (72%-94%) at 2 years; 84% (70%-94%) at 3 years; 75% (54%-90%) at 5 years; 66% (40%-86%) at 15 years; and 65% (39%-86%) at 20 years. The pooled survival estimates for neurologic stability (95% CrI) for moderate/severe DCM patients are: 83% (76%-89%) at 1 year; 72% (62%-81%) at 2 years; 71% (60%-80%) at 3 years; 55% (41%-68%) at 5 years; 44% (27%-59%) at 15 years; and 43% (25%-58%) at 20 years. CONCLUSIONS This is the first quantitative synthesis of the totality of published data on DCM natural history. Our review confirms a slow decline in neurologic function. We developed formulae which can be easily used by surgeons to communicate to patients their risk of neurologic deterioration. These formulae can be used to facilitate the shared decision-making process.
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Affiliation(s)
- Mohamed Sarraj
- McMaster University, Division of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada.
| | - Philip Hache
- McMaster University, Division of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Farid Foroutan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada; Department of Health Research, Methods, Impact, McMaster University, Hamilton, Ontario, Canada
| | - Colby Oitment
- McMaster University, Division of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Travis E Marion
- Department of Orthopaedic Surgery, Northern Ontario School of Medicine, Ontario, Canada
| | - Daipayan Guha
- McMaster University, Division of Neurosurgery, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Markian Pahuta
- McMaster University, Division of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada
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Rujeedawa T, Mowforth OD, Brannigan J, Magee J, Francis JJ, Laing RJ, Davies BM, Kotter MR. A single centre service evaluation of degenerative cervical and thoracic myelopathy. J Clin Neurosci 2023; 117:168-172. [PMID: 37826868 DOI: 10.1016/j.jocn.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) and degenerative thoracic myelopathy (DTM) present with leg, bladder and bowel symptoms. If imaging confirms spinal cord compression both conditions are usually managed surgically. Surgical timing is important in patient management as it affects post-operative recovery and long-term outcomes. This service evaluation aims to explore whether that patients with DTM are more likely to be treated urgently than those with DCM and to examine whether any differences in management are justified. METHODS A retrospective service evaluation was registered and approved by the Cambridge University Hospitals NHS Foundation Trust (CUH) Clinical Audit Department (Clinical Project ID4455 PRN10455). All patients who had undergone surgery for DTM at CUH from January 2015 until April 2022 were included. Comparison was made to a cohort of DCM patients who underwent surgery at CUH from June 2016 to January 2019. Data analysis was conducted in R. RESULTS A total of 130 DCM patients and 78 DTM patients were included. Our DCM and DTM patient cohorts had comparable demographics, but DTM patients had fewer spinal levels affected. Despite equivalent disease severity, DTM patients had a shorter time to diagnosis, shorter wait for surgery and were more likely to be operated on as an emergency case. CONCLUSIONS Despite comparable demographics and pathophysiology, DTM was diagnosed and managed more quickly than DCM. Better defined diagnostic pathways for degenerative spinal myelopathy may hold opportunities to optimise diagnosis and management, ensuring consistent high quality, efficient and equitable care.
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Affiliation(s)
- Tanzil Rujeedawa
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.
| | - Jamie Brannigan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Joe Magee
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jibin J Francis
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Rodney J Laing
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mark R Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Kim HW, Yong H, Shea GKH. Blood-spinal cord barrier disruption in degenerative cervical myelopathy. Fluids Barriers CNS 2023; 20:68. [PMID: 37743487 PMCID: PMC10519090 DOI: 10.1186/s12987-023-00463-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] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is the most prevalent cause of spinal cord dysfunction in the aging population. Significant neurological deficits may result from a delayed diagnosis as well as inadequate neurological recovery following surgical decompression. Here, we review the pathophysiology of DCM with an emphasis on how blood-spinal cord barrier (BSCB) disruption is a critical yet neglected pathological feature affecting prognosis. In patients suffering from DCM, compromise of the BSCB is evidenced by elevated cerebrospinal fluid (CSF) to serum protein ratios and abnormal contrast-enhancement upon magnetic resonance imaging (MRI). In animal model correlates, there is histological evidence of increased extravasation of tissue dyes and serum contents, and pathological changes to the neurovascular unit. BSCB dysfunction is the likely culprit for ischemia-reperfusion injury following surgical decompression, which can result in devastating neurological sequelae. As there are currently no therapeutic approaches specifically targeting BSCB reconstitution, we conclude the review by discussing potential interventions harnessed for this purpose.
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Affiliation(s)
- Hyun Woo Kim
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hu Yong
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China.
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11
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Liu J, Yang X, Jing W, Guo X, Wang R, Zhou J, Xue Y. Clinical efficacy of duloxetine in the treatment of axial symptoms after posterior cervical spine surgery: a retrospective study. J Orthop Surg Res 2023; 18:496. [PMID: 37438835 DOI: 10.1186/s13018-023-03970-8] [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: 02/20/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE To evaluate the efficacy of duloxetine in the treatment of patients with axial symptoms after posterior cervical spine surgery. METHODS Patients with axial symptoms after posterior cervical spine surgery treated by duloxetine or non-drug therapy from 2018 to 2021 were reviewed. Duloxetine was administered gradually, with oral administration of 30 mg in the first week and oral administration of 60 mg from the second week. Visual analogue scale (VAS), 36-Item Short-Form Health Survey questionnaire (SF-36) and EuroQol-5 Dimensions (EQ-5D) questionnaire were used to evaluate the severity of AS at baseline and 1 week, 2 weeks, 1 month, 3 months and 6 months after medication. The occurrence of adverse reactions was recorded. RESULTS A total of 63 eligible patients who received duloxetine therapy (n = 35) or non-drug therapy (n = 28) were included. All patients were followed up for 6 months. Significant improvements were found in VAS score compared with baseline in both groups (1.87 ± 0.81 vs 6.61 ± 1.16, 3.18 ± 0.67 vs 6.31 ± 1.40; P < 0.05 for all). Meanwhile, the VAS score of the duloxetine group was significantly better than that of the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). Besides, according to 36-Item Short-Form Health Survey questionnaire (SF-36), the PCS score and MCS score are significantly higher than before the treatment in duloxetine group (PCS 62.82 ± 6.04 vs 44.36 ± 7.25, MCS 65.50 ± 4.53 vs 55.55 ± 6.06; P < 0.05 for all). And when we compared variables between the two groups, the PCS score of the duloxetine group was significantly better than that of the non-drug therapy group (P < 0.05), but there was no significant difference in MCS score between the two groups (P > 0.05). What's more, EQ-5D score had significant improvements in the duloxetine group compared with the non-drug therapy group at 1 week, 2 weeks, 1 month, 3 months and 6 months (P < 0.05). CONCLUSION Oral duloxetine has a better short-term outcome than conventional non-drug therapy in patients with axial symptoms following posterior decompression surgery in the cervical spine.
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Affiliation(s)
- Jinkai Liu
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaotian Yang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Burn and Plastic Surgery, People's Hospital of Chongqing Hechuan, Chongqing, China
| | - Wanli Jing
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Orthopaedics, Tianjin First Central Hospital, Tianjin, China
| | - Xing Guo
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Wang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.
- Tianjin Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.
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Qiu C, Zhao Y, Wang L, Gao X, Yang W, Li H, Pan X, Li Y, Liu X, Wang S. Anterior cervical tunnectomy and fusion (ACTF): a novel technique for cervical canal decompression. 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 2023; 32:2110-2119. [PMID: 37067599 DOI: 10.1007/s00586-023-07691-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/22/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To describe a novel surgical technique note coined as anterior cervical tunnectomy and fusion (ACTF) which applying on removal of posterior vertebral bony protrusions or soft extrusions. METHODS Total twenty-three patients from January 2016 to January 2021 who experienced with spinal cord compression and performed by ACTF were retrospectively reviewed. Herein, relevant information including patient's gender, age, BMI, intraoperative time, intraoperative blood loss, postoperative complications and postoperative hospitalized stay were collected. Furthermore, JOA and VAS score were both collected. Moreover, imaging parameters were measured and calculated on radiographs. Correlated data were analyzed by t test. Significance was considered when P < 0.05. RESULTS All patients in this study were validated with favorable outcomes and none of postoperative complications. The Nurick grade of patients dramatically deceased postoperation (P < 0.001). And postoperative VAS score of patients (P < 0.001), as well as JOA score (P < 0.001), was given dramatical significance comparing to preoperation. Furthermore, occupying rate (OR) (P < 0.001) was obviously reduced while space available cord (SAC) (P < 0.001) and diameter of spinal cord (P < 0.001) was significantly increased postoperation. Meanwhile, disc height of involved segment, C2-7 SVA, and C2-C7 Cobb angle were measured on sagittal plane of lateral radiograph. Postoperative disc height of involved segment (P < 0.001) significantly elevated comparing to preoperation. However, there were no significance on C2-7 SVA (P = 0.460) and C2-C7 Cobb angle (P = 0.097). CONCLUSIONS The novel surgical technique coined by ACTF is a practicable approach during taking charge of bony and soft narrowing behind vertebral space.
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Affiliation(s)
- Cheng Qiu
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Yunpeng Zhao
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Lianlei Wang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xianlei Gao
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Wanliang Yang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Hao Li
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Xin Pan
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China
| | - Yuhua Li
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Xinyu Liu
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
| | - Songgang Wang
- Department of Orthopaedic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 107 Wenhuaxi Road, Jinan, 250012, Shandong, People's Republic of China.
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Muhammad F, Baha A, Haynes G, Shakir H, Omini M, Martin M, Weber KA, Paliwal M, Van Hal M, Dickson D, Dhaher Y, Zhao YD, Smith ZA. Isolating Neurologic Deficits in Cervical Spondylotic Myelopathy: A Case-Controlled Study, Using the NIH Toolbox Motor Battery. Neurol Clin Pract 2023; 13:e200126. [PMID: 37064579 PMCID: PMC10101713 DOI: 10.1212/cpj.0000000000200126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 03/10/2023]
Abstract
Background and Objectives Patients with cervical spondylotic myelopathy (CSM) have motor impairments, including weakness, imbalance, and loss of dexterity. The reliable assessment of these symptoms is critical for treatment decisions. This study aimed to determine, for the first time, the use of the NIH Toolbox motor battery (NIHTBm) in the objective assessment of motor deficits in patients with CSM. Methods Patients with symptoms and MRI evidence of CSM and age-matched healthy controls (HC), with no evidence of spinal disorder or surgery were included in this case-control study based on our inclusion and exclusion criteria. We performed motor tests, dexterity, gait speed, grip strength, and balance tests, using the NIHTBm in patients with CSM and HCs. Motor impairment rates were determined in patients with CSM based on the NIHTBm scores. We determined the association between NIHTBm scores and patient-reported outcome scores; patient-reported outcome measures (the modified Japanese Orthopedic Association [mJOA] and Nurick grade) to determine the association. One-way analysis of variance was used to analyze group differences and the Spearman rank correlation to determine the relationship between assessment scores. Results We enrolled 24 patients with CSM with a mean age (SD) of 57.96 (10.61) years and 24 age-matched HCs with a mean age (SD) of 53.17 (6.04) years in this study. Overall, we observed a significant decrease in the motor function T-scores mean (SD): dexterity 31.54 (14.82) vs 51.54 (9.72), grip strength 32.00 (17.47) vs 56.79 (8.46), balance 27.58 (16.65) vs 40.21 (6.35), and gait speed 0.64 (0.18) vs 0.99 (0.17) m/s, in patients with CSM compared with that in HCs. The lower extremity dysfunction scores on the NIHTBm, balance (ρ = -0.67) and gait speed (ρ = -0.62), were associated with higher Nurick grades. We observed a similar but weaker association with the Nurick grades and NIHTBm tests: dexterity (ρ = -0.49) and grip strength (ρ = -0.31) scores. The total motor mJOA showed a positive but weak association with NIHTBm scores, gait speed (ρ = 0.38), balance (ρ = 0.49), grip strength (ρ = 0.41), and dexterity (ρ = 0.45). Discussion Patients with CSM had significantly lower NIHTBm scores compared with HCs. The results from the NIHTBm are consistent with the clinical presentation of CSM showing patients have motor impairments in both upper and lower extremities. As a neurologic-specific scale, NIHTBm should be used in the evaluation and clinical management of patients with CSM.
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Affiliation(s)
- Fauziyya Muhammad
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Alaa Baha
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Grace Haynes
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Hakeem Shakir
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Omini
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Martin
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Kenneth A Weber
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Monica Paliwal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Van Hal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Douglas Dickson
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yasin Dhaher
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yan Daniel Zhao
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Zachary A Smith
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
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Lei CZ, Gong DJ, Zhou YF. Late‑onset white cord syndrome following anterior cervical discectomy and fusion: A case report. Exp Ther Med 2022; 25:71. [PMID: 36605533 PMCID: PMC9798147 DOI: 10.3892/etm.2022.11770] [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: 06/27/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
White cord syndrome refers to an emerging neurological dysfunction occurring after spinal decompression surgery with hyperenhancing changes on T2-weighted magnetic resonance imaging (T2WI). The pathophysiological mechanism is hypothesized to be an ischemia-reperfusion injury following chronic ischemic spinal cord decompression. A 54-year-old man was admitted to Jinhua Municipal Central Hospital with complaints of numbness and weakness in the extremities and swelling in the neck. MRI showed degeneration and herniation of the C4-C7 intervertebral discs. The patient underwent anterior cervical corpectomy and fusion (ACCF). On the 7th postoperative day, the patient reappeared with weakness of the limbs. Physical examination revealed paralysis. Emergency MRI suggested T2 high signal myelopathy and emergency surgery was performed following the diagnosis of white cord syndrome. Following the operation, the patient's neurological system gradually improved. The motor ability and sensory function of the extremities recovered at 7-month follow-up. Spine surgeons should be aware of this serious complication. The present case serves to provide experience for clinical treatment and diagnosis and encourage research into its pathophysiology.
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Affiliation(s)
- Chang-Zhen Lei
- Department of Surgery, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang 321000, P.R. China
| | - Dao-Jun Gong
- Department of Surgery, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang 321000, P.R. China,Correspondence to: Professor Dao-Jun Gong, Department of Surgery, Jinhua Hospital of Zhejiang University, 351 Ming Yue Street, Jinhua, Zhejiang 321000, P.R. China
| | - Yang-Fan Zhou
- Department of Orthopedics, Pan'an County Hospital of Traditional Chinese Medicine, Jinhua, Zhejiang 321000, P.R. China
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Quantitative physical performance tests can effectively detect Degenerative Cervical Myelopathy: A systematic review and meta-analysis. 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 2022; 31:3347-3364. [PMID: 36069938 DOI: 10.1007/s00586-022-07349-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/30/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE This review aimed to identify effective physical performance tests (PPT) as clinical outcome indicators for detecting and monitoring degenerative cervical myelopathy (DCM). METHODS A comprehensive literature search was performed on seven electronic databases on the effectiveness in detection and monitoring of DCM by PPT. All included studies were reviewed and undergone quality assessments on the risk-of-bias by Newcastle-Ottawa Scale and were pooled by random-effect analysis with level of significance at 0.05. Homogeneity among studies was assessed by I2-statistics and effect of PPT was confirmed by Cohen's d effect size and confidence intervals. RESULTS Totally, 3111 articles were retrieved, and 19 studies were included for review and meta-analysis. There were 13 studies investigating PPT regarding the upper limbs and 12 studies regarding the lower limbs. Performance in 10-second-Grip-and-Release Test (G&R) and 9-Hole-Peg Test (9HPT) was studied in 10 and 3 articles, respectively, while 10-second-Stepping Test (SST), 30-meter-Walking Test (30MWT) and Foot-Tapping Test (FTT) for lower limbs were studied in 5, 4, and 3 articles correspondingly. Only 1 study utilized the Triangle-Stepping Test. High-quality study with fair risk-of-bias was revealed from Newcastle-Ottawa scale. Large effect size facilitated detection and monitoring in DCM was unveiling for G&R, 9HPT, SST, and 30MWT. FTT, while also effective, was hindered by a high-degree heterogeneity in the meta-analysis. CONCLUSION Effective PPT including G&R, 9HPT, SST, 30MWT, and FTT was identified for disease detection and monitoring in DCM.
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Cervical microendoscopic laminoplasty-induced clinical resolution of disc herniation in patients with single- to three-level myelopathy. Sci Rep 2022; 12:18854. [PMID: 36344744 PMCID: PMC9640583 DOI: 10.1038/s41598-022-23747-z] [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: 01/28/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
This study aimed to explore the effects on resorption of cervical disc herniation (CDH) and clinical outcomes of surgery. Cervical microendoscopic laminoplasty (CMEL), which is commonly preferable to anterior corpectomy and fusion, was applied to patients with 1- to 3-level degenerative cervical myelopathy (DCM). DCM patients with 1-3 levels DCM underwent either conservation treatment or CMEL. In conservation-treated patients (53 cases), CDH volume remained unchanged with no improvement in JOA and VAS scores. Conversely, 63 patients with 1-3 levels DCM were prospectively enrolled and exhibited a profound decrease in CDH volume: 89.1% of CDHs (123/138) regressed over 10%, 64.5% of CDHs (89/138) regressed over 25%, while 27.5% and 6.5% of CDHs (38/138 and 9/138) largely regressed over 50% and 75%, respectively. Meanwhile, the JOA and VAS scores were improved in different ways. Intriguingly, CDH volume changes correlated significantly with elevations in JOA scores, indicating an association of clinical CDH resolution with neurological recovery. We showed that CMEL induced clinically related diminishment of CDH and alleviation of clinical symptoms in patients with 1- to 3-level myelopathy and that it could help avoid anterior dissection of the disc to some extent.
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Romagna A, Wilson JR, Jacobs WB, Johnson MG, Bailey CS, Christie S, Paquet J, Nataraj A, Cadotte DW, Manson N, Hall H, Thomas KC, Schwartz C, Rampersaud YR, McIntosh G, Fisher CG, Dea N. Factors Associated With Return to Work After Surgery for Degenerative Cervical Spondylotic Myelopathy: Cohort Analysis From the Canadian Spine Outcomes and Research Network. Global Spine J 2022; 12:573-578. [PMID: 33063549 PMCID: PMC9109566 DOI: 10.1177/2192568220958669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrosepctive analysis of prospectively collected data from the multicentre Canadian Surgical Spine Registry (CSORN). OBJECTIVE Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in North America. Few studies have evaluated return to work (RTW) rates after DCM surgery. Our goals were to determine rates and factors associated with postoperative RTW in surgically managed patients with DCM. METHODS Data was derived from the prospective, multicenter Canadian Spine Outcomes and Research Network (CSORN). From this cohort, we included all nonretired patients with at least 1-year follow-up. The RTW rate was defined as the proportion of patients with active employment at 1 year from the time of surgery. Unadjusted and adjusted analyses were used to identify patient characteristics, disease, and treatment variables associated with RTW. RESULTS Of 213 surgically treated DCM patients, 126 met eligibility, with 49% working and 51% not working in the immediate period before surgery; 102 had 12-month follow-up data. In both the unadjusted and the adjusted analyses working preoperatively and an anterior approach were associated with a higher postoperative RTW (P < .05), there were no significant differences between the postoperative employment groups with respect to age, gender, preoperative mJOA (modified Japanese Orthopaedic Association) score, and duration of symptoms (P > .05). Active preoperative employment (odds ratio = 15.4, 95% confidence interval = 4.5, 52.4) and anterior surgical procedures (odds ratio = 4.7, 95% confidence interval = 1.2, 19.6) were associated with greater odds of RTW at 1 year. CONCLUSIONS The majority of nonretired patients undergoing surgery for DCM had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with RTW in this analysis.
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Affiliation(s)
- Alexander Romagna
- University of Toronto, Toronto,
Ontario, Canada,Paracelsus Private Medical
University, Salzburg, Austria
| | | | | | | | | | | | - Jerome Paquet
- CHU de Quebec-Universite Laval,
Quebec City, Quebec, Canada
| | - Andrew Nataraj
- University of Alberta Hospital,
Edmonton, Alberta, Canada
| | | | - Neil Manson
- Dalhousie University, Saint John,
New Brunswick, Canada
| | | | | | | | | | - Greg McIntosh
- Canadian Spine Outcomes and
Research Network, Markdale, Ontario, Canada,Greg McIntosh, Canadian Spine Outcomes and
Research Network, 10 Armstrong Cres, PO Box 1053, Markdale, Ontario, Canada N0C
1H0.
| | - Charles G. Fisher
- Vancouver General Hospital,
Vancouver, British Columbia, Canada,University of British Columbia,
Vancouver, British Columbia, Canada
| | - Nicolas Dea
- Vancouver General Hospital,
Vancouver, British Columbia, Canada,University of British Columbia,
Vancouver, British Columbia, Canada
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Dijkman MD, van Bilsen MWT, Fehlings MG, Bartels RHMA. Long-term functional outcome of surgical treatment for degenerative cervical myelopathy. J Neurosurg Spine 2022; 36:830-840. [PMID: 34826817 DOI: 10.3171/2021.8.spine21651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0-18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10-12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.
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Affiliation(s)
- Mark D Dijkman
- 1Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- 2Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; and
| | - Martine W T van Bilsen
- 1Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- 2Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; and
| | | | - Ronald H M A Bartels
- 1Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
- 2Department of Neurosurgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; and
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19
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How Is Spinal Cord Function Measured in Degenerative Cervical Myelopathy? A Systematic Review. J Clin Med 2022; 11:jcm11051441. [PMID: 35268533 PMCID: PMC8910882 DOI: 10.3390/jcm11051441] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/21/2022] [Accepted: 02/23/2022] [Indexed: 12/10/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a prevalent condition in which spinal degeneration causes cord compression and neurological dysfunction. The spinal cord is anatomically complex and operates in conjunction with the brain, the musculoskeletal system, and numerous organs to control numerous functions, including simple and coordinated movement, sensation, and autonomic functions. As a result, accurate and comprehensive measurement of spinal cord function in patients with DCM and other spinal pathologies is challenging. This project aimed to summarize the neurological, functional, and quality of life (QoL) outcome measures currently in use to quantify impairment in DCM. A systematic review of the literature was performed to identify prospective studies with at least 100 DCM subjects that utilized one or more quantitative neurological, functional, or QoL outcome measures. A total of 148 studies were identified. The most commonly used instruments were subjective functional scales including the Japanese Orthopedic Association (JOA) (71 studies), modified JOA (mJOA) (66 studies), Neck Disability Index (NDI) (54 studies), and Nurick (39 studies), in addition to the QoL measure Short-Form-36 (SF-36, 52 studies). A total of 92% (320/349) of all outcome measures were questionnaires, whereas objective physical testing of neurological function (strength, gait, balance, dexterity, or sensation) made up 8% (29/349). Studies utilized an average of 2.36 outcomes measures, while 58 studies (39%) utilized only a single outcome measure. No studies were identified that specifically assessed the dorsal column sensory pathway or respiratory, bowel, or sexual function. In the past five years, there were no significant differences in the number of total, functional, or QoL outcome measures used, but physical testing of neurological function has increased (p = 0.005). Prior to 2017, cervical spondylotic myelopathy (CSM) was the most frequently used term to describe the study population, whereas in the last five years, DCM has become the preferred terminology. In conclusion, clinical studies of DCM typically utilize limited data to characterize impairment, often relying on subjective, simplistic, and non-specific measures that do not reflect the complexity of the spinal cord. Although accurate measurement of impairment in DCM is challenging, it is necessary for early diagnosis, monitoring for deterioration, and quantifying recovery after therapeutic interventions. Clinical decision-making and future clinical studies in DCM should employ a combination of subjective and objective assessments to capture the multitude of spinal cord functions to improve clinical management and inform practice guidelines.
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Nouri A, Tessitore E, Molliqaj G, Meling T, Schaller K, Nakashima H, Yukawa Y, Bednarik J, Martin AR, Vajkoczy P, Cheng JS, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Davies BM, Kotter MRN, Wilson JR. Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]. Global Spine J 2022; 12:39S-54S. [PMID: 35174726 PMCID: PMC8859703 DOI: 10.1177/21925682211036071] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). METHODS Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. RESULTS DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. CONCLUSION Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.
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Affiliation(s)
- Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Enrico Tessitore
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Granit Molliqaj
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Torstein Meling
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Joseph S. Cheng
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto, Ontario, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, FL, USA
| | - Benjamin M. Davies
- Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
| | - Mark R. N. Kotter
- Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
| | - Jefferson R. Wilson
- Division of Neurosurgery and Spine Program, University of Toronto, Ontario, Canada
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21
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Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VFJ, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time. Global Spine J 2022; 12:78S-96S. [PMID: 35174728 PMCID: PMC8859710 DOI: 10.1177/21925682211057546] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. METHODS Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. RESULTS Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. CONCLUSION Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
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Affiliation(s)
| | - Oliver Mowforth
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Genève, Switzerland
| | - Rana S. Dhillon
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia FJ Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James D. Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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22
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Abstract
Myelopathy can present acutely or more insidiously and has a broad differential diagnosis. In addition to the clinical history and neurologic examination, diagnostic testing, including MRI and cerebrospinal fluid analysis, as well as thorough review of patient comorbidities, risk factors, and potential toxic exposures, can help neurohospitalists distinguish between various causes and potentially start appropriate empiric therapy while awaiting definitive testing. This article focuses on how imaging can help in determining the most likely cause of myelopathy and highlights a range of causes, including compressive, vascular, metabolic and toxic, infectious, autoimmune, neoplastic, and paraneoplastic causes of spinal cord dysfunction.
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Affiliation(s)
- Anne G Douglas
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Denise J Xu
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Maulik P Shah
- Department of Neurology, University of California San Francisco, 505 Parnassus Avenue, Box 0114, San Francisco, CA 94143, USA.
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23
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Yin M, Xu C, Ma J, Ye J, Mo W. A Bibliometric Analysis and Visualization of Current Research Trends in the Treatment of Cervical Spondylotic Myelopathy. Global Spine J 2021; 11:988-998. [PMID: 32869687 PMCID: PMC8258815 DOI: 10.1177/2192568220948832] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN Bibliometric analysis. OBJECTIVE Cervical spondylotic myelopathy (CSM) has become the most common cause of spinal cord dysfunction. Many topics of CSM still remain controversial. This study aimed to illustrate the overall knowledge structure and development trends of CSM. METHODS Research data sets were acquired from the Web of Science database and the time span was defined as "2000 to 2019." VOS viewer and Citespace software was used to analyze the data and generate visualization knowledge maps. Annual trends of publications, distribution, H-index status, co-authorship status, and research hotspots were analyzed. RESULTS A total of 2367 publications met the requirement. The largest number of articles was from the United States, followed by Japan, China, Canada, and India. The highest H-index was found for articles from the United States. The highest number of articles was published in Spine. The cooperation between the countries, institutes, and authors were relatively weak. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM may become a frontier in this research field. CONCLUSION The number of publications showed an upward trend with a stable rise. Most of the publications are limited to a few countries and institutions with relatively weak interaction. The United States, Canada, Japan, China, and India have made significant contributions to the field of CSM. The United States is the country with the highest productivity, not only in quality but also in quantity. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM are the research hotspots in the recent years.
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Affiliation(s)
- Mengchen Yin
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Mengchen Yin and Chongqing Xu are co–first authors of this article, contributing equally to the design and drafting of the manuscript
| | - Chongqing Xu
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Mengchen Yin and Chongqing Xu are co–first authors of this article, contributing equally to the design and drafting of the manuscript
| | - Junming Ma
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jie Ye
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China,Wen Mo, Department of Orthopaedics, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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24
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Ricciardi L, Scerrati A, Bonis PD, Miscusi M, Trungu S, Visocchi M, Papacci F, Raco A, Proietti L, Pompucci A, Olivi A, Montano N. Long-term Radiologic and Clinical Outcomes after Three-level Contiguous Anterior Cervical Diskectomy and Fusion without Plating: A Multicentric Retrospective Study. J Neurol Surg A Cent Eur Neurosurg 2021; 82:556-561. [PMID: 34010980 DOI: 10.1055/s-0041-1726112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) has been providing good surgical, clinical, and radiologic outcomes in patients suffering from cervical degenerative disk disease (DDD). However, the role of anterior plating is still debated, especially in three-level procedures. This study aimed to investigate long-term clinical and radiologic outcomes and complications after three-level contiguous ACDF without plating for cervical DDD. METHODS Two institutional databases were retrieved (January 2009-December 2014) for patients treated with three-level contiguous ACDF without plating. Minimum follow-up (FU) was 5 years. Demographical data, smoking status, implant types, Neck Disability Index (NDI), visual analog scale (VAS) for neck pain, complications, fusion rate, adjacent segment degeneration (ASD), cervical lordosis (CL), and residual segmental mobility were evaluated. RESULTS We enrolled 21 patients. Tantalum and carbon fiber cages were implanted, respectively, in 13 and 8 patients. The mean FU length was 5.76 ± 0.87 years. Mean NDI score was 78.29 ± 9.98% preoperatively and 8.29 ± 1.67% at last FU (p < 0.01), whereas mean VAS score decreased from 7.43 ± 1.14 preoperatively to 0.95 ± 0.95 at last FU (p < 0.01). Complications were one postoperative hematoma, one superficial wound infection, and five cases of postoperative dysphagia (recovered within 3 days). The fusion rate was 90% and ASD was reported in three (14%) cases. The mean CL was 6.33 ± 2.70 degrees preoperatively, 8.19 ± 1.97 degrees 3 months after surgery (p = 0.02), and 7.62 ± 1.96 degrees at latest FU. There was no residual mobility on every operated segment at last FU. The smoking status was an independent risk factor for nonfusion in this case series (p = 0.02). CONCLUSIONS Three-level contiguous ACDF without plating seems to be an effective treatment for cervical DDD. Properly designed comparative clinical trials are needed to further investigate this topic.
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Affiliation(s)
- Luca Ricciardi
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | - Alba Scerrati
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Anna, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Anna, Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italy
| | - Massimo Miscusi
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Sokol Trungu
- UO di Neurochirurgia, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy.,UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Massimiliano Visocchi
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Fabio Papacci
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Antonino Raco
- UOC di Neurochirurgia, Azienda Ospedaliera Sant'Andrea, Sapienza, Roma, Italy
| | - Luca Proietti
- UOC di Chirurgia Vertebrale, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Angelo Pompucci
- UOC di Neurochirurgia, Ospedale Santa Maria Goretti, Latina, Italy
| | - Alessandro Olivi
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
| | - Nicola Montano
- UOC di Neurochirurgia, Fondazione Policlinico Universitario A. Gemelli IRCCS, UCSC, Roma, Italy
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Smith SS, Stewart ME, Davies BM, Kotter MRN. The Prevalence of Asymptomatic and Symptomatic Spinal Cord Compression on Magnetic Resonance Imaging: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:597-607. [PMID: 32677521 PMCID: PMC8119927 DOI: 10.1177/2192568220934496] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Cervical spinal cord compression (SCC) due to degenerative changes of the spine is a frequent finding on magnetic resonance imaging (MRI). While most people remain asymptomatic, a proportion develop symptoms of degenerative cervical myelopathy (DCM). DCM is an often-progressive neurological disease that can cause quadriplegia. The epidemiology of SCC and DCM is poorly understood. We sought to estimate the prevalence of degenerative cervical SCC and DCM from cross-sectional cohorts undergoing MRI. METHODS We conducted a systematic review and meta-analysis of MRI reports on human subjects older than 16 years with degenerative SCC. A predetermined search strategy was used to identify relevant literature on MEDLINE. Title and abstract screenings were followed by full text screening. Data was extracted and analyzed by fixed or random-effects models. RESULTS The present search returned 1506 publications. Following our exclusion criteria, 19 studies were included. Subgroup analysis of 3786 individuals estimated the prevalence of asymptomatic SCC in a healthy population as 24.2% with a significantly higher prevalence of SCC in older populations compared with younger populations and American/European populations compared with Asian populations. Subgroup analysis of 1202 individuals estimated the prevalence of DCM in a healthy population as 2.3%. CONCLUSIONS We present the first estimates of the prevalence of asymptomatic SCC and DCM. Studies investigating the epidemiology of SCC are heterogeneous in methodology and results. These data indicate the need for more studies into the epidemiology of SCC and DCM performed with consistent methodologies.
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Affiliation(s)
| | | | | | - Mark R. N. Kotter
- University of Cambridge, Cambridge, UK,Mark R. N. Kotter, Department of Clinical
Neurosciences, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK.
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Lee R, Lee D, Gowda NB, Iweala U, Weinreb JH, Falk DP, Yu W, O'Brien JR. Increased Rates of Septic Shock, Cardiac Arrest, and Mortality Associated With Chronic Steroid Use Following Anterior Cervical Discectomy and Fusion for Cervical Stenosis. Int J Spine Surg 2020; 14:649-656. [PMID: 33046542 DOI: 10.14444/7095] [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] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is an established treatment modality for cervical spondylosis. Many patients are on immunosuppressant therapy in the management of various inflammatory spinal pathologies and other comorbid conditions. The impact of chronic steroid use on postoperative complications has not been examined in cervical fusion procedures. The objective of this study was to identify specific postoperative complications associated with steroid/immunosuppressant use following ACDF for cervical stenosis. METHODS A multi-institutional surgical registry was queried to identify 5377 patients with ACDF diagnosed with cervical stenosis. Patients were stratified into cohorts with a history of steroid/immunosuppressant use for chronic conditions (n = 198, 3.3%) versus those who did not (n = 5179, 96.7%). Propensity-score matching without replacement was implemented to control for preoperative demographics and comorbidities. Pearson χ2 and Fischer exact tests were used in comparing the prevalence of demographics, comorbidities, and complication rates. RESULTS Upon propensity matching, increased rates of pulmonary embolisms (0.51% vs 0.00%, P = .025), cardiac arrest requiring resuscitation (1.01% vs 0.10%, P = .020), septic shock (0.51% vs 0.00%, P = .025), and mortality (1.52% vs 0.20%, P = .009) in the postoperative 30-day period in patients on chronic steroid/immunosuppressant use were observed. CONCLUSIONS The results indicate that steroid use/immunosuppression in patients with ACDF has a higher associated rate of pulmonary embolisms, cardiac arrest, septic shock, and mortality. The risk of mortality and these other complications should be carefully considered prior to operative intervention. Future research may investigate steroid-tapering protocols that reduce the rate of infection and other postoperative complications in the subset of immunosuppressed ACDF patients. CLINICAL RELEVANCE By elucidating the complication rates of ACDF patients on steroids for cervical stenosis, orthopedic surgeons can better stratify patients for risk of postoperative morbidity. Surgeons may have deeper risk-benefit discussions with these specific patients before they elect to have the operation.
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Affiliation(s)
- Ryan Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Danny Lee
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Nikhil B Gowda
- The George Washington University School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia
| | - Uchechi Iweala
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Jeffrey H Weinreb
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - David P Falk
- Department of Orthopaedic Surgery, University of Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Warren Yu
- Department of Orthopaedic Surgery, The George Washington University Hospital, Washington, District of Columbia
| | - Joseph R O'Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda, Bethesda, Maryland
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Lee R, Lee D, Iweala U, Ramamurti P, Weinreb JH, O’Brien JR. Outcomes following outpatient anterior cervical discectomy and fusion for the treatment of myelopathy. J Clin Orthop Trauma 2020; 15:161-167. [PMID: 33717932 PMCID: PMC7920123 DOI: 10.1016/j.jcot.2020.07.030] [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: 04/25/2020] [Revised: 06/14/2020] [Accepted: 07/26/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Anterior cervical discectomy and fusion (ACDF) is a commonly performed procedure for the treatment of degenerative cervical disease. With continued increase in U.S. healthcare expenditure, surgeons have begun to more closely examine the benefits of performing ACDF in an outpatient setting to increase efficiency, reduce the overall financial burden on patients/providers, and provide streamlined care for these patients. The purpose of this study was to analyze outcomes following outpatient ACDF for the treatment of myelopathy. METHODS 14,490 patients who had undergone ACDF for myelopathy from 2010 to 2018 were included in this retrospective study, of which 2956 (20.40%) patients were considered to have undergone outpatient surgery. Pearson chi-squared tests and Fischer's Exact Tests were used to analyze differences in categorical variables of demographics, preoperative comorbidities, and postoperative complications, while Mann-Whitney-U-Tests were used to compare mean values of continuous variables. Coarsened-exact-matching (CEM) was implemented to control for baseline differences in demographics and comorbidities, and post-matching diagnostics included multivariate and univariate imbalance measure assessment. Outcomes were compared between the CEM-matched inpatient and outpatients ACDF cohorts. RESULTS Upon CEM-matching (L1-statistic <0.001), the outpatient cohort (n = 2610, 25.13%) demonstrated significantly lower rates of any complication (p < 0.001), minor complications (p = 0.001), urinary tract infections (p = 0.029), blood transfusions (p < 0.001), major complications (p < 0.001), deep incisional surgical site infections (p = 0.017), ventilator dependence (p = 0.027), cardiac arrest (p = 0.028), unplanned reoperations (p = 0.001), and mortality (p = 0.006) in the 30-day postoperative period when compared to inpatient controls (n = 7774, 74.87%). CONCLUSION ACDF has been a target amongst spinal procedures as a prime candidate for outpatient surgery. However, no previous reports have described complication rates and perioperative parameters in the sub-population of outpatient ACDF patients with myelopathy. In addition to shorter times from admission to operating room, operative time, and LOS, our study also demonstrated lower rates of major and overall complications in outpatient ACDF's for myelopathy in comparison to their inpatient counterparts. Performing ACDF's for myelopathy in an outpatient setting may help to curb costs, improve outcomes, and serve as a valuable learning resource for graduate medical education with rapid turnovers and shorter operative times.
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Affiliation(s)
- Ryan Lee
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA,Corresponding author. The George Washington University School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC, 20037, USA.
| | - Danny Lee
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Uchechi Iweala
- Division of Spine Surgery, New York University Langone Orthopaedic Hospital in New York, NY, USA
| | - Pradip Ramamurti
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Jeffrey H. Weinreb
- Department of Orthopaedic Surgery, The George Washington University in Washington, DC, USA
| | - Joseph R. O’Brien
- Washington Spine and Scoliosis Clinic, OrthoBethesda in Bethesda, MD, USA
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Genitiempo M, Perna A, Santagada DA, Meluzio MC, Proietti L, Bocchi MB, Logroscino CA, Tamburrelli FC. Single-level Bryan cervical disc arthroplasty: evaluation of radiological and clinical outcomes after 18 years of follow-up. 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 2020; 29:2823-2830. [PMID: 32529522 DOI: 10.1007/s00586-020-06486-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/30/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Many studies reported mid-term clinical and radiological outcomes after cervical disc arthroplasty. Only a few studies analysed the long-term results. The aim of the study was to evaluate the clinical and radiological outcomes in patients treated with single-level Bryan cervical disc arthroplasty after 18 years of follow-up. METHODS This study was a retrospective analysis of institutional databases concerning patients treated with Bryan cervical disc arthroplasty. SF36 PCS, NDI and VAS were used to evaluate clinical and functional outcomes. Standard, flexion-extension X-ray and MRI were used to evaluate the radiological results. RESULTS Fifty-seven patients treated with single-level Bryan cervical disc arthroplasty completed the 18-year follow-up. At the final follow-up, a residual movement was observed in 32 patients (56%). The treated level range of motion decreased from 10.1° pre-operatively to 6.1° at the last follow-up (p = 0.0021). The range of motion of the adjacent segments and of the cervical spine had no significant change. Disc degeneration of the adjacent segment after 18-year follow-up was observed in 77.1% of treated patients. CONCLUSION The clinical and radiographic outcomes 18 years after surgery are acceptable. The treated level range of motion reduction and the adjacent segment degeneration seems not to affect the clinical results after 18 years of follow-up.
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Affiliation(s)
- Maurizio Genitiempo
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Andrea Perna
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.
| | - Domenico Alessandro Santagada
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Maria Concetta Meluzio
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Luca Proietti
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Beatrice Bocchi
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy
| | - Carlo Ambrogio Logroscino
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ciro Tamburrelli
- Istituto di Clinica Ortopedica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Largo A. Gemalli, 8, 00168, Rome, Italy.,Istituto di Clinica Ortopedica, Università Cattolica del Sacro Cuore, Rome, Italy
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Mowforth OD, Davies BM, Goh S, O’Neill CP, Kotter MRN. Research Inefficiency in Degenerative Cervical Myelopathy: Findings of a Systematic Review on Research Activity Over the Past 20 Years. Global Spine J 2020; 10:476-485. [PMID: 32435569 PMCID: PMC7222686 DOI: 10.1177/2192568219847439] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Scoping review. OBJECTIVE To describe activity, themes and trends in degenerative cervical myelopathy (DCM) research over the past 20 years with a view to considering DCM research inefficiency. METHODS A systematic review of MEDLINE and Embase for "Cervical" AND "Myelopathy" was conducted following PRISMA guidelines. Full-text papers in English, exclusively studying DCM, published between January 1, 1995 and December 31, 2015 were considered eligible. Country of origin, number of papers published, number of patients studied, research theme, and year of publication were assessed. Comparison was made between developed and developing countries. RESULTS A total of 1485 papers and 4 117 051 patients were included. Japan published more papers (450) than any other country while the United States studied the greatest number of patients (3 674 737). Over 99.4% of papers and 78.6% of patients were from developed countries. The number of papers (r = 0.96, P < .001) and patients (r = 0.83 P < .001) studied each year increased significantly overall and for both developed (r = 0.93, P < .001; r = 0.81, P < .001) and developing countries (r = 0.90, P < .001; r = 0.87, P < .001). Surgery was the most prevalent theme (58.3% papers; 55.7% patients) for developed and developing countries. Research from developing countries showed greater thematic variability. CONCLUSIONS DCM research activity is increasing internationally, with surgery remaining the focus. Research output has predominantly been from developed countries; however, the rate of growth for developed and developing countries is comparable.
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Affiliation(s)
- Oliver D. Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Joint first authors
| | - Benjamin M. Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Joint first authors
| | - Samuel Goh
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Cormac P. O’Neill
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Mark R. N. Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
- Wellcome Trust and MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, United Kingdom
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30
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Ojo OA, Ikwuegbuenyi CA. Cervical Decompression for Myelopathy in a Resource-Poor Region: Initial Experience. World Neurosurg 2020; 140:e283-e288. [PMID: 32413562 DOI: 10.1016/j.wneu.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this study was to document the initial experience and challenges of cervical decompression in a resource-poor region. METHODS Forty-three patients with cervical myelopathy who had surgery were included in the study. Details including evaluations pre- and postoperative (at 6 weeks and 6 months) using the Nurick score were recorded prospectively. Details of surgery were also documented. RESULTS The mean age at surgery was 58.0 years. There were 37 men and 6 women. Surgeries performed were anterior cervical decompression and fusion (51.2%), cervical laminectomy (32.6%), corpectomy and occipitocervical fixation (2.3% each), and decompression with lateral mass fixation (11.6%). Four patients presented within 3 months of onset of symptoms (early), whereas 39 after 3 months (late). The Nurick grade significantly improved in 41 patients (97.6%) following surgery (P < 0.001). The average Nurick preoperative score was 3.2, and postoperative it was 2.12 and 1.14 at 6 weeks and 6 months, respectively. In the early presentation group, scores improved from an average preoperative of 2.5-0.5 at 6 months, whereas in the late presentation group, score improved from an average of 3.3 preoperative to 1.2 at 6 months postoperative. CONCLUSIONS Despite the challenges of poverty, late presentation, and lack of basic standard instruments and equipment, patients with cervical myelopathy in the resource-poor setting had outcomes similar to other well-established centers after surgical decompression. We infer that challenges in setting up a spine unit in a resource-poor region can be circumvented safely.
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Affiliation(s)
- Omotayo A Ojo
- Department of Surgery, College of Medicine of University of Lagos, Lagos, Nigeria.
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31
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How common is repeat surgery and multi-level treatment in Degenerative Cervical Myelopathy? Findings from a patient perspective survey. J Clin Neurosci 2020; 77:181-184. [PMID: 32360164 DOI: 10.1016/j.jocn.2020.04.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/20/2020] [Indexed: 11/21/2022]
Abstract
Degenerative Cervical Myelopathy (DCM) is a common condition which causes significant disability and reduces health-related quality of life. The only evidence-based treatment and current management guidance is surgery to decompress the spinal cord and stop further damage in moderate to severe cases. However, this guidance is mainly informed by studies that only include first time surgery and/or single level disease, but DCM can reoccur after primary surgery and affect multiple levels of the spine. It is unclear whether patients in these subgroups; repeat surgery and multi-level DCM, differ significantly in their baseline and disease characteristics from those with single-level, single-operation disease. To investigate this, we conducted an online survey of people with DCM looking at key demographic, disease (e.g. mJOA) and treatment characteristics. We received a total of 778 respondents, of which 159 (20%) had undergone surgery for DCM. Around 75% of these respondents had a single operation and 65% at a single level. We found no statistically significant difference in key participant and disease characteristics between respondents with single-level or single-operation and those with multi-level DCM or multiple operations. These data support generalisability of research to these subgroups but also warrants further investigations as these subgroups are underrepresented in current research.
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32
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Weinberg DS, Rhee JM. Cervical laminoplasty: indication, technique, complications. JOURNAL OF SPINE SURGERY 2020; 6:290-301. [PMID: 32309667 DOI: 10.21037/jss.2020.01.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Cervical laminoplasty is a non-fusion, decompression procedure for cervical spondylotic myelopathy (CSM). It is most commonly indicated for patients with multilevel stenosis who have preserved sagittal alignment and minimal to no axial neck pain related to spondylosis. Expansion of the laminar arch can allow for direct and indirect decompression of the spinal canal. Relative contraindications include those patients with significant preoperative neck pain, kyphotic alignment and substantial instability. Potential advantages over laminectomy and fusion include avoiding fusion-related complications, and the preservation of motion. Important technical considerations include meticulous extensor muscle management, with special attention being given to preserving the soft tissue attachments to C2. In the properly selected patient, outcomes are comparable, and in some studies superior, to other operations for CSM.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, The Emory Spine Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John M Rhee
- Department of Orthopaedic Surgery, The Emory Spine Center, Emory University School of Medicine, Atlanta, Georgia, USA
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33
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Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol 2020; 16:108-124. [PMID: 31974455 DOI: 10.1038/s41582-019-0303-0] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.
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34
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Mowforth OD, Starkey ML, Kotter MR, Davies BM. Letter to the Editor. The need for research prioritization in cervical myelopathy. J Neurosurg Spine 2020; 32:777-779. [PMID: 31899877 DOI: 10.3171/2019.11.spine191300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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35
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Jiang F, Wilson JRF, Badhiwala JH, Santaguida C, Weber MH, Wilson JR, Fehlings MG. Quality and Safety Improvement in Spine Surgery. Global Spine J 2020; 10:17S-28S. [PMID: 31934516 PMCID: PMC6947676 DOI: 10.1177/2192568219839699] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Review article. OBJECTIVES A narrative review of the literature on the current advances and limitations in quality and safety improvement initiatives in spine surgery. METHODS A comprehensive literature search was performed using Ovid MEDLINE focusing on 3 preidentified concepts: (1) quality and safety improvement, (2) reporting of outcomes and adverse events, and (3) prediction model and practice guidelines. The search was conducted under appropriate subject headings and using relevant text words. Articles were screened, and manuscripts relevant to this discussion were included in the narrative review. RESULTS Quality and safety improvement remains a major research focus attracting investigators from the global spine community. Multiple databases and registries have been developed for the purpose of generating data and monitoring the progress of quality and safety improvement initiatives. The development of various prediction models and clinical practice guidelines has helped shape the care of spine patients in the modern era. With the reported success of exemplary programs initiated by the Northwestern and Seattle Spine Team, other quality and safety improvement initiatives are anticipated to follow. However, despite these advancements, the reporting metrics for outcomes and adverse events remain heterogeneous in the literature. CONCLUSION Constant surveillance and continuous improvement of the quality and safety of spine treatments is imperative in modern health care. Although great advancement has been made, issues with reporting outcomes and adverse events persist, and improvement in this regard is certainly needed.
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Affiliation(s)
- Fan Jiang
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jamie R. F. Wilson
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | - Jetan H. Badhiwala
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University of Toronto, Toronto, Ontario, Canada,Michael G. Fehlings, Division of Neurosurgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, Ontario, M5T2S8, Canada.
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36
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The role of cervical collar in functional restoration and fusion after anterior cervical discectomy and fusion without plating on single or double levels: a systematic review and meta-analysis. 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 2020; 29:955-960. [DOI: 10.1007/s00586-019-06270-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
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37
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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38
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Parthiban J, Alves OL, Chandrachari KP, Ramani P, Zileli M. Value of Surgery and Nonsurgical Approaches for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations. Neurospine 2019; 16:403-407. [PMID: 31607072 PMCID: PMC6790727 DOI: 10.14245/ns.1938238.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/26/2019] [Indexed: 12/21/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a common cause of adult spinal cord dysfunction. Although the therapeutic options for moderate to severe CSM patients have been established well, the existing guidelines for therapeutic decisions in mild cases of CSM are unclear. We present a review of literature on conservative treatment and surgery for CSM and suggest general recommendations applicable in various clinical presentations and in different geographic locations across the globe, with due considerations to available resources and locally prevalent practices.
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Affiliation(s)
- Jutty Parthiban
- Department of Neurosurgery, Kovai Medical Center Hospital, Coimbatore, India
| | - Oscar L Alves
- Department of Neurosurgery, Hospital Lusiadas Porto, Porto, Portugal
| | | | | | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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39
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Badiee RK, Chan AK, Rivera J, Molinaro A, Doherty BR, Riew KD, Chou D, Mummaneni PV, Tan LA. Preoperative Narcotic Use, Impaired Ambulation Status, and Increased Intraoperative Blood Loss Are Independent Risk Factors for Complications Following Posterior Cervical Laminectomy and Fusion Surgery. Neurospine 2019; 16:548-557. [PMID: 31607087 PMCID: PMC6790747 DOI: 10.14245/ns.1938198.099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/20/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE This retrospective cohort study seeks to identify risk factors associated with complications following posterior cervical laminectomy and fusion (PCLF) surgery. METHODS Adults undergoing PCLF from 2012 through 2018 at a single center were identified. Demographic and radiographic data, surgical characteristics, and complication rates were compared. Multivariate logistic regression models identified independent predictors of complications following surgery. RESULTS A total of 196 patients met the inclusion criteria and were included in the study. The medical, surgical, and overall complication rates were 10.2%, 23.0%, and 29.1% respectively. Risk factors associated with medical complications in multivariate analysis included impaired ambulation status (odds ratio [OR], 2.27; p=0.02) and estimated blood loss over 500 mL (OR, 3.67; p=0.02). Multivariate analysis revealed preoperative narcotic use (OR, 2.43; p=0.02) and operative time (OR, 1.005; p=0.03) as risk factors for surgical complication, whereas antidepressant use was a protective factor (OR, 0.21; p=0.01). Overall complication was associated with preoperative narcotic use (OR, 1.97; p=0.04) and higher intraoperative blood loss (OR, 1.0007; p=0.03). CONCLUSION Preoperative narcotic use and estimated blood loss predicted the incidence of complications following PCLF for CSM. Ambulation status was a significant predictor of the development of a medical complication specifically. These results may help surgeons in counseling patients who may be at increased risk of complication following surgery.
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Affiliation(s)
- Ryan K Badiee
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Andrew K Chan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Joshua Rivera
- Department of Integrative Biology, University of California, Berkeley, Berkeley, CA, USA
| | - Annette Molinaro
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Brianna R Doherty
- University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - K Daniel Riew
- The Spine Hospital, New York Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Dean Chou
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Praveen V Mummaneni
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
| | - Lee A Tan
- Department of Neurological Surgery, UCSF Medical Center, San Francisco, San Francisco, CA, USA
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40
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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: 34] [Impact Index Per Article: 6.8] [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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Montano N, Ricciardi L, Olivi A. Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes. World Neurosurg 2019; 130:530-536.e2. [PMID: 31254693 DOI: 10.1016/j.wneu.2019.06.144] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Spondylotic cervical myelopathy is a severe condition commonly affecting aging people. Although many investigations have been conducted, a consensus on the best surgical management is still missing. The aim of our study was to systematically review the pertinent literature and carry out a meta-analysis to compare the clinical and radiological outcome of the anterior cervical decompression and fusion (ACDF) and the posterior laminoplasty. METHODS This study was conducted in agreement with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines statement. Different medical database (PubMed, Embase, Scopus) were screened for eligible scientific reports. The key words "cervical," "spondylosis," "myelopathy," "laminoplasty," "ACDF" (MeSH) have been used in any possible combination. As outcome variables, the Japanese Orthopedic Association score, operation time, blood loss, cervical lordosis, range of motion and, complications were evaluated. RESULTS A total of 626 articles were screened and 5 finally included in the meta-analysis. Comparing the anterior cervical decompression and fusion (ACDF) and laminoplasty groups, no differences were found in Japanese Orthopedic Association score, operation time, and complication rate. The ACDF was associated with lower intraoperative blood loss and better cervical lordosis preservation, whereas the laminoplasty was associated with a wider cervical range of motion. CONCLUSIONS The results of this meta-analysis seem to suggest that ACDF should be preferred to the laminoplasty for the treatment of multilevel cervical myelopathy, although proper designed randomized controlled clinical trials are needed to further investigate this relevant ongoing issue.
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Affiliation(s)
- Nicola Montano
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.
| | - Luca Ricciardi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Alessandro Olivi
- Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Davies BM, Khan DZ, Mowforth OD, McNair AGK, Gronlund T, Kolias AG, Tetreault L, Starkey ML, Sadler I, Sarewitz E, Houlton D, Carter J, Kalsi-Ryan S, Aarabi B, Kwon BK, Kurpad SN, Harrop J, Wilson JR, Grossman R, Curt A, Fehlings MG, Kotter MRN. RE-CODE DCM ( REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy): A Consensus Process to Improve Research Efficiency in DCM, Through Establishment of a Standardized Dataset for Clinical Research and the Definition of the Research Priorities. Global Spine J 2019; 9:65S-76S. [PMID: 31157148 PMCID: PMC6512197 DOI: 10.1177/2192568219832855] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN Mixed-method consensus process. OBJECTIVES Degenerative cervical myelopathy (DCM) is a common and disabling condition that arises when mechanical stress damages the spinal cord as a result of degenerative changes in the surrounding spinal structures. RECODE-DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) aims to improve efficient use of health care resources within the field of DCM by using a multi-stakeholder partnership to define the DCM research priorities, to develop a minimum dataset for DCM clinical studies, and confirm a definition of DCM. METHODS This requires a multi-stakeholder partnership and multiple parallel consensus development processes. It will be conducted via 4 phases, adhering to the guidance set out by the COMET (Core Outcomes in Effectiveness Trials) and JLA (James Lind Alliance) initiatives. Phase 1 will consist of preliminary work to inform online Delphi processes (Phase 2) and a consensus meeting (Phase 3). Following the findings of the consensus meeting, a synthesis of relevant measurement instruments will be compiled and assessed as per the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) criteria, to allow recommendations to be made on how to measure agreed data points. Phase 4 will monitor and promote the use of eventual recommendations. CONCLUSIONS RECODE-DCM sets out to establish for the first time an index term, minimum dataset, and research priorities together. Our aim is to reduce waste of health care resources in the future by using patient priorities to inform the scope of future DCM research activities. The consistent use of a standard dataset in DCM clinical studies, audit, and clinical surveillance will facilitate pooled analysis of future data and, ultimately, a deeper understanding of DCM.
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Affiliation(s)
- Benjamin M Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Danyal Z Khan
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Toto Gronlund
- James Lind Alliance, National Institute for Health Research, Southampton, UK
| | - Angelos G Kolias
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Lindsay Tetreault
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L Starkey
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-LC, University Health Network, Toronto, Ontario, Canada
| | | | - Brian K Kwon
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - James Harrop
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | - Armin Curt
- Balgrist University Hospital, Zurich, Switzerland
| | - Michael G Fehlings
- Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark R N Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wellcome Trust & MRC Cambridge Stem Cell Institute, Cambridge, UK
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Heller RA, Seelig J, Bock T, Haubruck P, Grützner PA, Schomburg L, Moghaddam A, Biglari B. Relation of selenium status to neuro-regeneration after traumatic spinal cord injury. J Trace Elem Med Biol 2019; 51:141-149. [PMID: 30466924 DOI: 10.1016/j.jtemb.2018.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/07/2018] [Accepted: 10/04/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The trace element selenium (Se) is crucial for the biosynthesis of selenoproteins. Both neurodevelopment and the survival of neurons that are subject to stress depend on a regular selenoprotein biosynthesis and sufficient Se supply by selenoprotein P (SELENOP). HYPOTHESIS Neuro-regeneration after traumatic spinal cord injury (TSCI) is related to the Se status. STUDY DESIGN Single-centre prospective observational study. PATIENTS AND METHODS Three groups of patients with comparable injuries were studied; vertebral fractures without neurological impairment (n = 10, group C), patients with TSCI showing no remission (n = 9, group G0), and patients with remission developing positive abbreviated injury score (AIS) conversion within 3 months (n = 10, group G1). Serum samples were available from different time points (upon admission, and after 4, 9 and 12 h, 1 and 3 days, 1 and 2 weeks, and 1, 2 and 3 months). Serum trace element concentrations were determined by total reflection X-ray fluorescence, SELENOP by ELISA, and further parameters by laboratory routine. RESULTS Serum Se and SELENOP concentrations were higher on admission in the remission group (G1) as compared to G0. During the first week, both parameters remained constant in C and G0, whereas they declined significantly in the remission group. Similarly, the concentration changes between admission and 24 h were most pronounced in this group of recovering patients (G1). Binary logistic regression analysis including the delta of Se and SELENOP within the first 24 h indicated an AUC of 90.0% (CI: 67.4%-100.0%) with regards to predicting the outcome after TSCI. CONCLUSION A Se deficit might constitute a risk factor for poor outcome after TSCI. A dynamic decline of serum Se and SELENOP concentrations after admission may reflect ongoing repair processes that are associated with higher odds for a positive clinical outcome.
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Affiliation(s)
- Raban Arved Heller
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Seelig
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bock
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Haubruck
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Paul Alfred Grützner
- BG Trauma Centre Ludwigshafen, Department of Trauma Surgery and Orthopedics, Medical Director, Ludwigshafen, Germany
| | - Lutz Schomburg
- Institute for Experimental Endocrinology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Arash Moghaddam
- Heidelberg Trauma Research Group, Department of Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Bahram Biglari
- BG Trauma Centre Ludwigshafen, Department of Paraplegiology, Ludwigshafen, Germany
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Efficacy and Safety of OnabotulinumtoxinA in Patients With Neurogenic Detrusor Overactivity Caused by Spinal Cord Injury: A Systematic Review and Meta-analysis. Int Neurourol J 2018; 22:275-286. [PMID: 30599499 PMCID: PMC6312972 DOI: 10.5213/inj.1836118.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/25/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose OnabotulinumtoxinA (BoNT-A) is a promising therapy for treating neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI). This systematic review and meta-analysis aimed to carry out an in-depth review and to make an objective estimation of the efficacy and safety of BoNT-A on NDO after SCI. Methods The PubMed, Embase, and Cochrane databases were searched for all relevant articles published from 2001 to 2016 that referred to NDO, SCI, and BoNT-A or botulinum toxin A. All data were recorded in an Excel spreadsheet by 2 individual reviewers. Review Manager version 5.3 was used to carry out the meta-analysis. Results This analysis included 17 studies involving 1,455 patients. Compared with placebo and baseline, BoNT-A was effective in increasing maximum cystometric capacity, volume at first involuntary detrusor contraction, cystometric bladder capacity (all P<0.00001), compliance (P=0.001), and the number of patients with complete dryness (P=0.0003), and decreasing detrusor pressure, the number of patients with no involuntary detrusor contractions, the maximum flow rate, the incidence of detrusor overactivity (all P<0.00001), and the number of urinary incontinence episodes (P=0.001). There were no statistically significant differences between doses of 200 U and 300 U or between injections into the detrusor and submucosa. There were no life-threatening adverse events. Conclusions BoNT-A is effective and safe in treating NDO after SCI. There were no statistically significant differences between doses of 200 U and 300 U or between injecting into the detrusor and submucosa. However, more high-quality randomized controlled trials are still needed.
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Tetreault L, Wilson JR, Kotter MRN, Côté P, Nouri A, Kopjar B, Arnold PM, Fehlings MG. Is Preoperative Duration of Symptoms a Significant Predictor of Functional Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy? Neurosurgery 2018; 85:642-647. [DOI: 10.1093/neuros/nyy474] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/12/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Preoperative duration of symptoms may significantly impact outcomes in patients treated surgically for degenerative cervical myelopathy (DCM).
OBJECTIVE
To (i) analyze whether duration of symptoms is associated with preoperative functional impairment, disability, and quality of life and (ii) determine the optimal timing for decompressive surgery.
METHODS
Patients with DCM were prospectively enrolled in either the AOSpine North American or International study at 26 global sites (n = 757). Postoperative functional impairment was evaluated at 1-yr using the modified Japanese Orthopaedic Association (mJOA) score. Change scores between baseline and 1-yr were computed for the mJOA. Duration of symptoms was dichotomized into a “short” and “long” group at several cut-offs. Analysis of covariance was used to evaluate differences in change scores on the mJOA between duration of symptoms groups in 4-mo increments.
RESULTS
Our cohort consisted of 424 men and 255 women, with a mean duration of symptoms of 26.1 ± 36.4 mo (0.25-252 mo). Duration of symptoms was not correlated with preoperative mJOA, Nurick, Neck Disability Index, or Short-Form (SF)-36 Physical and Mental Component Scores. Patients with a duration of symptoms shorter than 4 mo had significantly better functional outcomes on the mJOA than patients with a longer duration of symptoms (>4 mo). Thirty-two months was also a significant cut-off.
CONCLUSION
Patients who are operated on within 4 mo of symptom presentation have better mJOA outcomes than those treated after 4 mo. It is recommended that patients with DCM are diagnosed in a timely fashion and managed appropriately.
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Affiliation(s)
- Lindsay Tetreault
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Graduate Entry Medicine, University College Cork, Cork, Ireland
| | - Jefferson R Wilson
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mark R N Kotter
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom
| | - Pierre Côté
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Aria Nouri
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Branko Kopjar
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas, Kansas City, Kansas
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Augusto MT, Diniz JM, Dantas FLR, Oliveira MFD, Rotta JM, Botelho RV. Development of the Portuguese Version of the Modified Japanese Orthopaedic Association Score: Cross-Cultural Adaptation, Reliability, Validity, and Responsiveness. World Neurosurg 2018; 116:e1092-e1097. [PMID: 29864576 DOI: 10.1016/j.wneu.2018.05.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Spondylotic cervical myelopathy (SCM) is a common cause of spinal-related disability in elderly patients. The assessment of this disability is a challenging task and depends on the subjective evaluation of the investigator. As a widespread-used scale, the modified version of the Japanese Orthopaedic Association score (mJOA) should be translated and culturally adapted in the Brazilian Portuguese language (i.e., mJOA-Br) to provide its clinical and research use. This study aimed to perform translation, transcultural adaptation, and validation of the mJOA into Brazilian Portuguese. METHODS Following the transcultural adaptation model described by Guillemin et al., the scale as translated into Brazilian Portuguese and back-translated to English. Afterwards, questionnaires were applied in consecutive patients with SCM and compared with a control group (without SCM). The final scale was compared with the Brazilian version of Neck Disability Index for validation. RESULTS Sixty patients were submitted to the translated version of mJOA. There was a strong correlation between mJOA-Br scores and Neck Disability Index scores to evaluate SCM symptoms (R = -0.75). CONCLUSIONS mJOA-Br was considered a valid and reliable tool to evaluate patients with SCM.
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Affiliation(s)
- Mateus Tomaz Augusto
- Post Graduation Program in Health Sciences, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil.
| | - Juliete Melo Diniz
- Post Graduation Program in Health Sciences, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | - Matheus Fernandes de Oliveira
- Post Graduation Program in Health Sciences, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Biocor, Belo Horizonte, Minas Gerais, Brazil
| | - José Marcus Rotta
- Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Ricardo Vieira Botelho
- Post Graduation Program in Health Sciences, Instituto de Assistência Médica ao Servidor Público Estadual, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil; Department of Neurosurgery, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
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