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Wathen CA, Jacob AT, Bohorquez D, Mannikarottu C, Marcotte P. Treatment strategies for cervical spondylotic myelopathy-is laminectomy alone a safe and effective option? JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:344-353. [PMID: 39399067 PMCID: PMC11467276 DOI: 10.21037/jss-22-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/31/2024] [Indexed: 10/15/2024]
Abstract
Background Cervical laminectomy may be underutilized in the treatment of cervical spondylotic myelopathy (CSM) due to concerns regarding potential for post-operative instability and/or kyphosis. The purpose of this retrospective, observational study is to assess the short-term clinical and radiological outcomes as well as complications associated with a group of carefully selected patients who underwent laminectomy alone for CSM and compared them to a cohort of patients who underwent laminectomy with fusion. Methods Patients with CSM were identified via review of a single surgeon's cases. All patients underwent preoperative clinical evaluation, lateral flexion-extension cervical radiographs, and documentation of neck and/or extremity pain via Nurick Scale and modified Japanese Orthopedic Association (JOA) scores. Postoperative follow-up occurred at 1, 3 and 6 months for all patients. Statistical analysis was performed via Student's t-test for parametric values and Wilcoxon (Mann-Whitney) rank sum test for ordinal scores. Multi-variable linear regression was used to correct for co-variance. Results Forty-one patients who underwent laminectomy alone and 13 patients who underwent laminectomy with fusion were identified who met inclusion criteria. Both groups demonstrated significant improvement on Nurick and JOA scores postoperatively. Two patients in the laminectomy alone group required a subsequent one-level anterior cervical discectomy and fusion for onset of postoperative neck pain, without neurological symptoms or new deficits in the follow up period. There was no difference in rates of post-operative kyphosis between the groups. Conclusions In appropriately selected patients without pre-operative kyphosis or abnormal motion on flexion-extension films, cervical laminectomy remains a safe and effective treatment option.
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Affiliation(s)
- Connor A. Wathen
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arun T. Jacob
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Northeast Georgia Physician’s Group, Gainesville, GA, USA
| | - Dominique Bohorquez
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL, USA
| | - Carthi Mannikarottu
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Marcotte
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Deshmukh SS, Harjpal P. Rehabilitation of Cervical Spondylotic Myelopathy and Carotid Space Schwannoma: A Case Report. Cureus 2024; 16:e67789. [PMID: 39323675 PMCID: PMC11423181 DOI: 10.7759/cureus.67789] [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: 07/03/2024] [Accepted: 08/25/2024] [Indexed: 09/27/2024] Open
Abstract
Compression of the spinal cord at the cervical level of the spinal column is the hallmark of the disorder known as cervical myelopathy. The aberrant reflexes, hyperreflexia, pathologic reflexes, clumsiness in the hands and fingers, and disturbance of the gait are caused by this compression. It usually starts slowly, increases gradually, and eventually results in a functional decline. For patients older than 55, the most common cause of spinal cord dysfunction is cervical spondylotic myelopathy (CSM). The traditional definition of the pathogenesis of CSM is multilevel spondylosis, where osteophytes develop as a consequence of disc degeneration. The connection between myelopathy and increasing cervical kyphosis, however, has not received much attention. Myelopathy develops as a result of the kyphosis pushing the spinal cord against the vertebral bodies, causing disease in the anterior cord and increasing longitudinal cord strain because of the cord's tethering by the cervical nerve root and dentate ligaments. Because schwannomas in the carotid area are located close to important neurovascular structures, they can provide particular diagnostic and treatment issues. This case report focuses on the management of a rare condition of CSM and carotid space schwannoma by various neurophysiotherapy approaches over six weeks of rehabilitation.
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Affiliation(s)
- Siddhant S Deshmukh
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro-Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Thompson K, Travers H, Ngan A, Reed T, Shahsavarani S, Verma RB. Updates in current concepts in degenerative cervical myelopathy: a systematic review. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:313-326. [PMID: 38974484 PMCID: PMC11224794 DOI: 10.21037/jss-23-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/20/2024] [Indexed: 07/09/2024]
Abstract
Background The incidence of degenerative cervical myelopathy (DCM) has increased over the years due to an increasing aging population, yet there is a dearth of recent comprehensive data evaluating the multiple facets of this degenerative condition. Recent publications have highlighted the biochemistry and biomechanics of DCM, which are paramount to understanding the degenerative nature of the condition and selecting the most optimal treatment options for improved patient outcomes. In addition, there have been recent studies establishing the superiority of surgical to non-surgical treatments for DCM, which until now was a poorly substantiated claim that has permeated the medical field for decades. The authors of this systematic review sought to collect and assess available high quality peer reviewed data to analyze the nature of DCM and gain a better understanding for its treatment choices. Methods PubMed and Cochrane Central Register of Controlled Trials were systematically searched on January 19, 2023 with date restrictions of 2015-2023 imposed. For initial data collection, five independent searches were completed using the following keywords: pathogenesis, pathophysiology, and epidemiology of DCM; cervical spondylotic myelopathy (CSM) and DCM recent developments; management and treatment for CSM and DCM; diagnosis and management of DCM; and pathophysiology of DCM. The results were screened for their application to DCM; any study that did not directly address DCM were identified and removed through abstract assessment, such studies included those pertaining to alternative fields including cardiology and psychiatry. Studies found relevant through full-text assessment and those published in English were included in this study and unpublished studies and studies found irrelevant based on titles and keywords were excluded from this study. The 115 articles that met criteria were critically appraised independently by the 2 reviewers and the principles of Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were applied to assess the quality of evidence from each study. Results A total of 352 studies resulted from the original search. There were 71 duplicate articles that were removed and a total of 281 articles were screened. 166 articles were then removed based on the exclusion/inclusion criteria, title, and abstract. Of the 138 articles that remained, a final list of 115 articles was created based on the reporting measures. Conclusions DCM is a multifactorial disease that has the potential to impair neurological function and cause significant paralysis. Although the multiple facets of this disease have not been fully elucidated, there have been significant breakthroughs in understanding the mechanisms involved in this disease process. The use of complex imaging modalities, genetic sequencing, biomarkers, and pharmacological agents has provided insight into the factors involved in the progression of DCM, which has consequently cultivated more refined approaches for diagnosis and treatment of DCM.
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Affiliation(s)
- Kiara Thompson
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Hannah Travers
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Alex Ngan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY, USA
| | - Tim Reed
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery at Huntington Hospital, Huntington, NY, USA
| | - Shaya Shahsavarani
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Rohit B. Verma
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Orthopedic Surgery, North Shore University Hospital-Long Island Jewish Medical Center, Manhasset, NY, USA
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Şerifoğlu L, Etli MU. Prospective Investigation of the Posterior Longitudinal Ligament and Disc Complex after Posterior Stabilization and Decompression Surgery in Patients With Non-OPLL (Ossification of the Posterior Longitudinal Ligament) Cervical Spondylotic Myelopathy. World Neurosurg 2024; 184:e384-e389. [PMID: 38302004 DOI: 10.1016/j.wneu.2024.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in adults, primarily from degenerative changes. The efficacy of treatment strategies, especially surgical approaches, remains debated. OBJECTIVE This study aimed to assess the long-term impact of posterior fusion laminectomy on the posterior longitudinal ligament (PLL) thickness, disc complex, and myelomalacia signal changes in CSM patients. METHODS A single-centre, prospective study from January 2020 to December 2021 included CSM patients without ossified posterior longitudinal ligament (OPLL). Magnetic resonance imaging (MRI) data from baseline, 6, and 12 months postoperatively were collected. Measurements on the MRI were performed using the Osirix MD software, focusing on the PLL width, myelopathic foci dimensions, and canal diameter. RESULTS Out of the 82 initially enrolled patients, 64 were considered for analysis. Postoperatively, a significant reduction in PLL width and myelopathic foci dimensions was observed, alongside a considerable increase in the canal diameter. Clinical outcomes based on the Modified Japanese Orthopaedic Association (mJOA) scale also showcased marked improvements post-surgery. CONCLUSIONS Posterior fusion laminectomy effectively reduces anterior pressure in CSM patients. This treatment may represent an optimal surgical approach for selected CSM cases. Furthermore, more extensive studies with extended follow-up are advocated.
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Affiliation(s)
- Luay Şerifoğlu
- Department of Neurosurgery, Ümraniye Training and Research Hospital, Istanbul, Turkey.
| | - Mustafa Umut Etli
- Department of Neurosurgery, Ümraniye Training and Research Hospital, Istanbul, Turkey
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Khan AF, Muhammad F, Mohammadi E, O'Neal C, Haynes G, Hameed S, Walker B, Rohan ML, Yabluchanskiy A, Smith ZA. Beyond the aging spine - a systematic review of functional changes in the human brain in cervical spondylotic myelopathy. GeroScience 2024; 46:1421-1450. [PMID: 37801201 PMCID: PMC10828266 DOI: 10.1007/s11357-023-00954-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/31/2023] [Indexed: 10/07/2023] Open
Abstract
Cervical Spondylotic Myelopathy (CSM) is a degenerative condition that leads to loss of cervical spinal cord integrity, typically affecting the aged population. Emerging fMRI-based evidence suggests that the brain is also affected by CSM. This systematic review aimed to understand the usefulness of brain fMRI in CSM. A comprehensive literature search was conducted until March 2023 according to PRISMA guidelines. The inclusion criteria included original research articles in English, primarily studying the human brain's functional changes in CSM using fMRI with at least 5 participants. The extracted data from each study included demographics, disease severity, MRI machine characteristics, affected brain areas, functional changes, and clinical utilities. A total of 30 studies met the inclusion criteria. Among the fMRI methods, resting-state fMRI was the most widely used experimental paradigm, followed by motor tasks. The brain areas associated with motor control were most affected in CSM, followed by the superior frontal gyrus and occipital cortex. Functional changes in the brain were correlated to clinical metrics showing clinical utility. However, the evidence that a specific fMRI metric correlating with a clinical metric was "very low" to "insufficient" due to a low number of studies and negative results. In conclusion, fMRI can potentially facilitate the diagnosis of CSM by quantitatively interrogating the functional changes of the brain, particularly areas of the brain associated with motor control. However, this field is in its early stages, and more studies are needed to establish the usefulness of brain fMRI in CSM.
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Affiliation(s)
- Ali Fahim Khan
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA.
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Esmaeil Mohammadi
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Christen O'Neal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Grace Haynes
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK, USA
| | - Sanaa Hameed
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
| | - Brynden Walker
- College of Arts and Sciences, University of Oklahoma, Norman, OK, USA
| | | | - Andriy Yabluchanskiy
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zachary Adam Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, 1000 N Lincoln Blvd, Suite 4000, Oklahoma City, OK, 73104, 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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7
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Danielsen E, Ingebrigtsen T, Gulati S, Salvesen Ø, Johansen TO, Nygaard ØP, Solberg TK. Patient Characteristics Associated With Worsening of Neck Pain-Related Disability After Surgery for Degenerative Cervical Myelopathy: A Nationwide Study of 1508 Patients. Neurosurgery 2024:00006123-990000000-01043. [PMID: 38323820 DOI: 10.1227/neu.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/17/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Functional status, pain, and quality of life usually improve after surgery for degenerative cervical myelopathy (DCM), but a subset of patients report worsening. The objective was to define cutoff values for worsening on the Neck Disability Index (NDI) and identify prognostic factors associated with worsening of pain-related disability 12 months after DCM surgery. METHODS In this prognostic study based on prospectively collected data from the Norwegian Registry for Spine Surgery, the NDI was the primary outcome. Receiver operating characteristics curve analyses were used to obtain cutoff values, using the global perceived effect scale as an external anchor. Univariable and multivariable analyses were performed using mixed logistic regression to evaluate the relationship between potential prognostic factors and the NDI. RESULTS Among the 1508 patients undergoing surgery for myelopathy, 1248 (82.7%) were followed for either 3 or 12 months. Of these, 317 (25.4%) were classified to belong to the worsening group according to the mean NDI percentage change cutoff of 3.3. Multivariable analyses showed that smoking (odds ratio [OR] 3.4: 95% CI 1.2-9.5: P < .001), low educational level (OR 2.5: 95% CI 1.0-6.5: P < .001), and American Society of Anesthesiologists grade >II (OR 2.2: 95% CI 0.7-5.6: P = .004) were associated with worsening. Patients with more severe neck pain (OR 0.8: 95% CI 0.7-1.0: P = .003) and arm pain (OR 0.8: 95% CI 0.7-1.0; P = .007) at baseline were less likely to report worsening. CONCLUSION We defined a cutoff value of 3.3 for worsening after DCM surgery using the mean NDI percentage change. The independent prognostic factors associated with worsening of pain-related disability were smoking, low educational level, and American Society of Anesthesiologists grade >II. Patients with more severe neck and arm pain at baseline were less likely to report worsening at 12 months.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tonje O Johansen
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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Onofrei LV. Structural Myelopathies. Continuum (Minneap Minn) 2024; 30:73-98. [PMID: 38330473 DOI: 10.1212/con.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This article illustrates the clinical importance, diagnosis, and management of degenerative and nondegenerative structural myelopathies. It also aims to create a diagnostic approach for the evaluation of patients with suspected degenerative myelopathies. LATEST DEVELOPMENTS There is considerable interest in developing diagnostic methods that can assist in deciding if surgery is indicated in patients with structural myelopathy and the optimal timing for surgery. Diffusion tensor imaging has emerged as a promising imaging modality although it is not used routinely in clinical practice. Neuroprotective medications and interventions are being studied in patients with degenerative myelopathies. ESSENTIAL POINTS Structural myelopathies and particularly degenerative myelopathies are common disorders that are routinely encountered in clinical practice, with symptoms that frequently overlap with other neurologic disorders. The prompt diagnosis and treatment of patients are essential in achieving good functional outcomes.
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9
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Gallagher DO, Taghlabi KM, Bondar K, Saifi C. Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach. Clin Spine Surg 2024; 37:1-8. [PMID: 38285428 DOI: 10.1097/bsd.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 05/09/2023] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS An extensive literature review was conducted. RESULTS The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.
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Affiliation(s)
- Daniel O Gallagher
- Department of Education, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Kevin Bondar
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Comron Saifi
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
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10
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Fan X, Chen R, Huang H, Zhang G, Zhou S, Chen X, Zhao Y, Diao Y, Pan S, Zhang F, Sun Y, Zhou F. Classification and prognostic factors of patients with cervical spondylotic myelopathy after surgical treatment: a cluster analysis. Sci Rep 2024; 14:99. [PMID: 38167939 PMCID: PMC10762243 DOI: 10.1038/s41598-023-49477-4] [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: 05/07/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Identifying potential prognostic factors of CSM patients could improve doctors' clinical decision-making ability. The study retrospectively collected the baseline data of population characteristics, clinical symptoms, physical examination, neurological function and quality of life scores of patients with CSM based on the clinical big data research platform. The modified Japanese Orthopedic Association (mJOA) score and SF-36 score from the short-term follow-up data were entered into the cluster analysis to characterize postoperative residual symptoms and quality of life. Four clusters were yielded representing different patterns of residual symptoms and quality of patients' life. Patients in cluster 2 (mJOA RR 55.8%) and cluster 4 (mJOA RR 55.8%) were substantially improved and had better quality of life. The influencing factors for the better prognosis of patients in cluster 2 were young age (50.1 ± 11.8), low incidence of disabling claudication (5.0%) and pathological signs (63.0%), and good preoperative SF36-physiological function score (73.1 ± 24.0) and mJOA socre (13.7 ± 2.8); and in cluster 4 the main influencing factor was low incidence of neck and shoulder pain (11.7%). We preliminarily verified the reliability of the clustering results with the long-term follow-up data and identified the preoperative features that were helpful to predict the prognosis of the patients. This study provided reference and research basis for further study with a larger sample data, extracting more patient features, selecting more follow-up nodes, and improving clustering algorithm.
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Affiliation(s)
- Xiao Fan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Rui Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Haoge Huang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Gangqiang Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shuai Zhou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xin Chen
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yanbin Zhao
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yinze Diao
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shengfa Pan
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Fengshan Zhang
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Feifei Zhou
- Department of Orthopaedics, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, 49 North Garden Road, Haidian District, Beijing, 100191, China.
- Beijing Key Laboratory of Spinal Disease Research, 49 North Garden Road, Haidian District, Beijing, 100191, China.
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11
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Sweetman H, Rahman M, Vedantam A, Satkunendrarajah K. Subclinical respiratory dysfunction and impaired ventilatory adaptation in degenerative cervical myelopathy. Exp Neurol 2024; 371:114600. [PMID: 37907124 DOI: 10.1016/j.expneurol.2023.114600] [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: 08/16/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/02/2023]
Abstract
Degenerative cervical myelopathy (DCM) is a debilitating neurological condition characterized by chronic compression of the cervical spinal cord leading to impaired upper and lower limb function. Despite damage to areas of the cervical spinal cord that house the respiratory network, respiratory dysfunction is not a common symptom of DCM. However, DCM may be associated with respiratory dysfunction, and this can affect the ventilatory response to respiratory challenges during emergence from anesthesia, exercise, or pulmonary disease. Surgical spinal cord decompression, which is the primary treatment for DCM, leads to improved sensorimotor function in DCM; yet its impact on respiratory function is unknown. Here, using a clinically relevant model of DCM, we evaluate respiratory function during disease progression and assess adaptive ventilation to hypercapnic challenge before and after surgical intervention. We show that despite significant and progressive forelimb and locomotor deficits, there was no significant decline in eupneic ventilation from the early to late phases of spinal cord compression. Additionally, for the first time, we demonstrate that despite normal ventilation under resting conditions, DCM impairs acute adaptive ventilatory ability in response to hypercapnia. Remarkably, akin to DCM patients, surgical decompression treatment improved sensorimotor function in a subset of mice. In contrast, none of the mice that underwent surgical decompression recovered their ability to respond to hypercapnic ventilatory challenge. These findings underscore the impact of chronic spinal cord compression on respiratory function, highlighting the challenges associated with ventilatory response to respiratory challenges in individuals with DCM. This research highlights the impact of cervical spinal cord compression on respiratory dysfunction in DCM, as well as the persistence of adaptive ventilatory dysfunction after surgical spinal cord decompression. These results indicate the need for additional interventions to enhance recovery of respiratory function after surgery for DCM.
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Affiliation(s)
- Hannah Sweetman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Mahmudur Rahman
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aditya Vedantam
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA
| | - Kajana Satkunendrarajah
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA; Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, WI, USA; Department of Physiology, Medical College of Wisconsin, Milwaukee, WI, USA.
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12
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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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13
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Saunders LM, Sandhu HS, McBride L, Maniarasu VS, Taylor S, Dhokia R. Degenerative Cervical Myelopathy: An Overview. Cureus 2023; 15:e50387. [PMID: 38213348 PMCID: PMC10783125 DOI: 10.7759/cureus.50387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
Degenerative cervical myelopathy (DCM) is a spinal condition of growing importance due to its increasing prevalence within the ageing population. DCM involves the degeneration of the cervical spine due to various processes such as disc ageing, osteophyte formation, ligament hypertrophy or ossification, as well as coexisting congenital anomalies. This article provides an overview of the literature on DCM and considers areas of focus for future research. A patient with DCM can present with a variety of symptoms ranging from mild hand paraesthesia and loss of dexterity to a more severe presentation of gait disturbance and loss of bowel/bladder control. Hoffman's sign and the inverted brachioradialis reflex are also important signs of this disease. The gold standard imaging modality is MRI which can identify signs of degeneration of the cervical spine. Other modalities include dynamic MRI, myelography, and diffusion tensor imaging. One important scoring system to aid with the diagnosis and categorisation of the severity of DCM is the modified Japanese Orthopaedic Association score. This considers motor, sensory, and bowel/bladder dysfunction, and categorises patients into mild, moderate, or severe DCM. DCM is primarily treated with surgery as this can halt disease progression and may even allow for neurological recovery. The surgical approach will depend on the location of degeneration, the number of cervical levels involved and the pathophysiological process. Surgical approach options include anterior cervical discectomy and fusion, corpectomy, or posterior approach (laminectomy ± fusion). Conservative management is also considered for some patients with mild or non-progressive DCM or for patients where surgery is not an option. Conservative treatment may include physical therapy, traction, or neck immobilisation. Future recommendations include research into the prevalence rate of DCM and if there is a difference between populations. Further research on the benefit of conservative management for patients with mild or non-progressive DCM would be recommended.
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Affiliation(s)
- Laura M Saunders
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Hushil S Sandhu
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
| | - Lorcán McBride
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | | | - Samantha Taylor
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, GBR
| | - Rakesh Dhokia
- Department of Trauma and Orthopaedics, Royal Victoria Hospital, Belfast, GBR
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14
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Sangeorzan I, Antonacci G, Martin A, Grodzinski B, Zipser CM, Murphy RKJ, Andriopoulou P, Cook CE, Anderson DB, Guest J, Furlan JC, Kotter MRN, Boerger TF, Sadler I, Roberts EA, Wood H, Fraser C, Fehlings MG, Kumar V, Jung J, Milligan J, Nouri A, Martin AR, Blizzard T, Vialle LR, Tetreault L, Kalsi-Ryan S, MacDowall A, Martin-Moore E, Burwood M, Wood L, Lalkhen A, Ito M, Wilson N, Treanor C, Dugan S, Davies BM. Toward Shared Decision-Making in Degenerative Cervical Myelopathy: Protocol for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e46809. [PMID: 37812472 PMCID: PMC10594151 DOI: 10.2196/46809] [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: 03/09/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Health care decisions are a critical determinant in the evolution of chronic illness. In shared decision-making (SDM), patients and clinicians work collaboratively to reach evidence-based health decisions that align with individual circumstances, values, and preferences. This personalized approach to clinical care likely has substantial benefits in the oversight of degenerative cervical myelopathy (DCM), a type of nontraumatic spinal cord injury. Its chronicity, heterogeneous clinical presentation, complex management, and variable disease course engenders an imperative for a patient-centric approach that accounts for each patient's unique needs and priorities. Inadequate patient knowledge about the condition and an incomplete understanding of the critical decision points that arise during the course of care currently hinder the fruitful participation of health care providers and patients in SDM. This study protocol presents the rationale for deploying SDM for DCM and delineates the groundwork required to achieve this. OBJECTIVE The study's primary outcome is the development of a comprehensive checklist to be implemented upon diagnosis that provides patients with essential information necessary to support their informed decision-making. This is known as a core information set (CIS). The secondary outcome is the creation of a detailed process map that provides a diagrammatic representation of the global care workflows and cognitive processes involved in DCM care. Characterizing the critical decision points along a patient's journey will allow for an effective exploration of SDM tools for routine clinical practice to enhance patient-centered care and improve clinical outcomes. METHODS Both CISs and process maps are coproduced iteratively through a collaborative process involving the input and consensus of key stakeholders. This will be facilitated by Myelopathy.org, a global DCM charity, through its Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy community. To develop the CIS, a 3-round, web-based Delphi process will be used, starting with a baseline list of information items derived from a recent scoping review of educational materials in DCM, patient interviews, and a qualitative survey of professionals. A priori criteria for achieving consensus are specified. The process map will be developed iteratively using semistructured interviews with patients and professionals and validated by key stakeholders. RESULTS Recruitment for the Delphi consensus study began in April 2023. The pilot-testing of process map interview participants started simultaneously, with the formulation of an initial baseline map underway. CONCLUSIONS This protocol marks the first attempt to provide a starting point for investigating SDM in DCM. The primary work centers on developing an educational tool for use in diagnosis to enable enhanced onward decision-making. The wider objective is to aid stakeholders in developing SDM tools by identifying critical decision junctures in DCM care. Through these approaches, we aim to provide an exhaustive launchpad for formulating SDM tools in the wider DCM community. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46809.
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Affiliation(s)
| | - Grazia Antonacci
- Department of Primary Care and Public Health, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, Imperial College London, London, United Kingdom
- Centre for Health Economics and Policy Innovation (CHEPI), Business School, Imperial College London, London, United Kingdom
| | - Anne Martin
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, United Kingdom
| | - Ben Grodzinski
- University Hospitals Sussex, NHS Foundation Trust, Brighton, United Kingdom
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Rory K J Murphy
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Panoraia Andriopoulou
- Psychology Department, School of Social Sciences, University of Ioannina, Ioannina, Greece
| | - Chad E Cook
- Division of Physical Therapy, School of Medicine, Duke University, Durham, CA, United States
- Department of Orthopaedics, School of Medicine, Duke University, Durham, CA, United States
- Department of Population Health Sciences, School of Medicine, Duke University, Durham, CA, United States
- Duke Clinical Research Institute, Duke University, Durham, CA, United States
| | - David B Anderson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James Guest
- The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Julio C Furlan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mark R N Kotter
- Myelopathy.org, Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Helen Wood
- Myelopathy.org, Cambridge, United Kingdom
| | - Christine Fraser
- Department of Health Sciences, University of Stirling, Scotland, United Kingdom
- Physiotherapy Department, National Health Service Lothian, Edinburgh, United Kingdom
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Orthopaedics, All India Institute of Medical Sciences, Deoghar, India
| | - Josephine Jung
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - James Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Allan R Martin
- Department of Neurological Surgery, University of California, Davis, Davis, CA, United States
| | | | - Luiz Roberto Vialle
- School of Medicine, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Lindsay Tetreault
- Department of Neurology, New York University, New York, NY, United States
| | - Sukhvinder Kalsi-Ryan
- The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University and Department of Orthopaedics, The Academic Hospital of Uppsala, Uppsala, Sweden
| | | | | | - Lianne Wood
- Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- NeuroSpinal Assessment Unit, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Abdul Lalkhen
- Northern Care Alliance, Salford Royal NHS Foundation Trust, Manchester, United Kingdom
| | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Nicky Wilson
- Physiotherapy Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Treanor
- Department of Physiotherapy, Beaumont Hospital, Dublin, Ireland
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Benjamin M Davies
- Myelopathy.org, Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
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15
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Lenga P, Gülec G, Kiening K, Unterberg AW, Ishak B. Anterior cervical discectomy fusion versus posterior decompression and fusion in octogenarians with cervical myelopathy: Clinical outcomes and complications with a 3-year follow-up. BRAIN & SPINE 2023; 3:102683. [PMID: 38021012 PMCID: PMC10668093 DOI: 10.1016/j.bas.2023.102683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/20/2023] [Accepted: 09/29/2023] [Indexed: 12/01/2023]
Abstract
Introduction Cervical stenosis and concurrent Cervical Spondylotic Myelopathy (CSM) are prevalent in the elderly. Treatment options include Anterior Cervical Discectomy Fusion (ACDF) and Posterior Decompression and Fusion (PDF). Research question This study aims to compare clinical outcomes and complications between ACDF and PDF in patients aged 80 and above. Material and methods Data from electronic medical records between 2005 and 2021 at a single institution were analyzed. Logistic and linear regression analyses were performed to explore risk factors and the relationship between comorbidities and neurological conditions. Results 21 patients with ACDF and 26 with PDF were studied over 16 years. PDF patients had more operated levels, higher blood loss, and longer hospital stays, but mortality rates and mJOA improvements were similar in both groups. The presence of comorbidities was a unique risk factor for postoperative complications. Discussion and conclusion ACDF and PDF led to neurological improvements in elderly CSM patients. However, the decision of surgical procedure should carefully consider the potential for postoperative complications, particularly in patients with comorbidities.
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Affiliation(s)
- Pavlina Lenga
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gelo Gülec
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Karl Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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16
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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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17
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Naghdi N, Elliott JM, Weber MH, Fehlings MG, Fortin M. Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes. Front Neurol 2023; 14:1209475. [PMID: 37745653 PMCID: PMC10512835 DOI: 10.3389/fneur.2023.1209475] [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: 04/21/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objectives This study aimed to examine whether preoperative cervical muscle size, composition, and asymmetry from magnetic resonance imaging (MRI) can predict post-operative outcomes in patients with degenerative cervical myelopathy (DCM). Methods A total of 171 patients with DCM were included. Relative total cross-sectional area (RCSA), functional CSA (fat-free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together (MF + SCer), and cervical muscle as a group (MF, SCer, semispinalis capitis, and splenius capitis) were obtained from T2-weighted axial MR images at the mid-disk, at the level of maximum cord compression and the level below. Univariate and multivariate linear regression analyses were used to assess the relationship between baseline cervical muscle measurements of interest with the modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 health survey at 6-month and 12-month post-surgery. Results Lower RCSA of MF + SCer, less CSA MF + SCer asymmetry and greater FCSA/CSA for the cervical muscle group (e.g., less fatty infiltration), and younger age were significant predictors of higher mJOA scores (e.g., less disability) at 6-month and 12-month post-surgery (all p < 0.05). Greater CSA asymmetry in MF + SCer and lower FCSA/CSA (e.g., more fatty infiltration) for the cervical muscle group were significant predictors of higher Nurick scores (e.g., more disability) at 6-month and 12-month post-surgery (all p < 0.05). Lower FCSA MF + Scer asymmetry, lower FCSA/CSA asymmetry of the muscle group, and greater RCSA MF + SCer were significant predictors of higher NDI scores at 6-month and 12-month post-surgery. Finally, greater FCSA/CSA asymmetry of the MF + SCer, greater FCSA asymmetry of the muscle group, greater RCSA of the muscle group, and greater CSA asymmetry of MF + SCer were significant predictors of lower post-operative SF-36 scores at 6- and 12-month post-surgery. Conclusion Our result suggested that cervical paraspinal muscle morphology, specifically greater asymmetry, and fatty infiltration may be important predictors of functional recovery and post-surgical outcomes in patients with DCM.
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Affiliation(s)
- Neda Naghdi
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
| | - James M. Elliott
- The Kolling Institute, The University of Sydney, Sydney, NSW, Australia
- The Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Michael H. Weber
- Montreal General Hospital Site, Department of Orthopedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Michael G. Fehlings
- Department of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Maryse Fortin
- Department of Health, Kinesiology & Applied Physiology, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
- Centre de Recherche Interdisciplinaire en Readaptation (CRIR), Montreal, QC, Canada
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18
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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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19
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Bolles C, Battaglia P, Moore C. Varied presentations of cervical spondylotic myelopathy presenting to a chiropractic clinic: a report of 3 cases. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:146-156. [PMID: 36275077 PMCID: PMC9512298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Indexed: 06/16/2023]
Abstract
Cervical spondylotic myelopathy (CSM) is the leading cause of acquired spinal cord dysfunction worldwide and may be expected to increase in prevalence due to an aging global population. Clinical features of CSM are highly variable, and chiropractors frequently manage patients with common signs and symptoms of CSM such as neck pain, extremity weakness, and gait imbalances. Early recognition of signs consistent with myelopathy may mitigate future disability and improve quality of life. Key predictors of patient outcome are the age of initial presentation, baseline CSM severity (as measured by mJOA score), and the presence of gait disturbances. This report describes three cases of CSM presenting to a chiropractic clinic. Each case illustrates a unique manifestation of CSM, including myelopathy, myeloradiculopathy, and distal neuropathic pain (funicular referral). In addition, a review of CSM terminology, epidemiology, pathobiology, clinical features, imaging, and management is provided.
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Affiliation(s)
| | - Patrick Battaglia
- Director of Health Policy and Interdisciplinary Care, Logan University
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20
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Butler MB, Mowforth OD, Badran A, Starkey M, Boerger T, Sadler I, Tabrah J, Treanor C, Phys LCGD, Kalsi-Ryan S, Laing RJ, Davies BM, Kotter MRN. Provision and Perception of Physiotherapy in the Nonoperative Management of Degenerative Cervical Myelopathy (DCM): A Cross-Sectional Questionnaire of People Living With DCM. Global Spine J 2022; 12:638-645. [PMID: 33000656 PMCID: PMC9109573 DOI: 10.1177/2192568220961357] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES Degenerative cervical myelopathy (DCM) is a common syndrome of acquired spinal cord impairment caused by canal stenosis secondary to arthritic changes of the spine. International guidelines consider physiotherapy an option for mild, stable DCM; however, few studies have been conducted on nonoperative management. The objective was to determine current usage and perceptions of nonoperative physiotherapy for DCM. METHODS Persons with DCM were recruited to a web-based survey. Participants with complete responses that had not received surgery were included (n = 167). Variables included symptom duration, treatment history, current disability, and demographic characteristics. RESULTS Disease and demographic characteristics were equivalent between those who did and did not receive physiotherapy. In all, 19.5% of physiotherapy recipients reported subjective benefit from physiotherapy. Those perceiving benefit had significantly higher mJOA (modified Japanese Orthopaedic Association) scores, lower neck pain scores, and shorter symptom duration. In multivariate logistic regression analysis, those with mild DCM were more likely to perceive benefit than those with severe DCM, as were those with moderate DCM (to a lesser extent). Individuals whose diagnosis was delayed 1 to 2 years were less likely to perceive benefit than those that waited 0 to 6 months. CONCLUSIONS The provision of nonoperative physiotherapy in the management of DCM is inconsistent and appears to differ from international guidelines. Few patients perceived benefit from physiotherapy; however, this was more likely in those with mild DCM and in those with shorter symptom durations. Further work is needed to establish the appropriate role of physiotherapy for this population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Benjamin M. Davies
- University of Cambridge, Cambridge,
UK,* Joint senior authors,Benjamin M. Davies, Division of
Neurosurgery, Department of Clinical Neurosciences, University of Cambridge,
Cambridge, CB2 0SZ, UK.
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21
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Plener J, Ammendolia C, Hogg-Johnson S. Nonoperative management of degenerative cervical radiculopathy: protocol of a systematic review. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2022; 66:74-84. [PMID: 35655692 PMCID: PMC9103640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background Degenerative cervical radiculopathy (DCR) is a common condition which, due to the aging global population, is expected to worsen over time. For the majority of patients with DCR, surgical intervention is not required as nonoperative management is sufficient for symptom improvement. However, there are significant gaps within the literature as the majority of past systematic reviews assessing conservative interventions are outdated, or omit relevant studies due to strict inclusion/exclusion criteria. Therefore, an updated understanding of the effectiveness of noninvasive nonoperative management for DCR is required. Methods We will search MEDLINE, CENTRAL, Embase, PsycINFO, and CINAHL from inception, as well as hand-search reference lists of included studies and previous systematic reviews, to identify peer-reviewed randomized controlled trials on this topic. Discussion The results of this review will provide an understanding of the effectiveness of various nonoperative interventions. The quality of evidence will also be assessed using the GRADE approach. Systematic review registration PROSPERO CRD42021249699.
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Affiliation(s)
- Joshua Plener
- Division of Graduate Studies, Canadian Memorial Chiropractic College
- Institute for Health Policy Management and Evaluation, University of Toronto
| | - Carlo Ammendolia
- Institute for Health Policy Management and Evaluation, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto, Canada
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Department of Research and Innovation, Canadian Memorial Chiropractic College
- Dalla Lana School of Public Health, University of Toronto
- Institute for Disability and Rehabilitation Research
- Faculty of Health Sciences, Ontario Tech University
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22
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Boerger TF, Hyngstrom AS, Furlan JC, Kalsi-Ryan S, Curt A, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Wilson JR, Davies BM, Kotter MRN, Koljonen PA. Developing Peri-Operative Rehabilitation in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 6]: An Unexplored Opportunity? Global Spine J 2022; 12:97S-108S. [PMID: 35174735 PMCID: PMC8859699 DOI: 10.1177/21925682211050925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE Degenerative cervical myelopathy is one of the most frequent impairments of the spinal cord encountered internationally in adults. Currently, surgical decompression is the recommended treatment for people with DCM (PwCM) presenting with moderate to severe symptoms or neurological deficits. However, despite surgical intervention, not all patients make a complete recovery due to the irreversible tissue damage within the spinal cord. The objective of this review is to describe the state and gaps in the current literature on rehabilitation for PwCM and possible innovative rehabilitation strategies. METHODS Literature search. RESULTS In other neurological disorders such as stroke and acute traumatic spinal cord injury (SCI), timely and strategic rehabilitation has been shown to be indispensable for maximizing functional outcomes, and it is imperative that appropriate perioperative rehabilitative interventions accompany surgical approaches in order to enable the best outcomes. In this review, the current state of knowledge regarding rehabilitation for PwCM is described. Additionally, various therapies that have shown to improve outcomes in comparable neurological conditions such as stroke and SCI which may be translated to DCM will be reviewed. CONCLUSIONS We conclude that locomotor training and arm/hand therapy may benefit PwCM. Further, we conclude that body weight support, robotic assistance, and virtual/augmented reality therapies may be beneficial therapeutic analogs to locomotor and hand therapies.
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Affiliation(s)
- Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Julio C. Furlan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Brian K. Kwon
- Department of Orthopedics, Vancouver Spine Surgery Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | | | | | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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23
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Gharooni AA, Kwon BK, Fehlings MG, Boerger TF, Rodrigues-Pinto R, Koljonen PA, Kurpad SN, Harrop JS, Aarabi B, Rahimi-Movaghar V, Wilson JR, Davies BM, Kotter MRN, Guest JD. Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology. Global Spine J 2022; 12:109S-121S. [PMID: 35174725 PMCID: PMC8859698 DOI: 10.1177/21925682211052920] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' METHODS A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. RESULTS Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. CONCLUSION There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.
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Affiliation(s)
- Aref-Ali Gharooni
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin M. Davies
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mark R. N. Kotter
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
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24
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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 VF, 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)
- Benjamin M Davies
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Oliver Mowforth
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Aref-Ali Gharooni
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, 5894Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, 27230University of Geneva, Genève, Switzerland
| | - Rana S Dhillon
- Department of Neurosurgery, 60078St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, 37748Masaryk University, Brno, Czech Republic
| | - Allan R Martin
- Department of Neurosurgery, 8789University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, 12978Niigata University, Niigata, Japan
| | - Timothy F Boerger
- Department of Neurosurgery, 5506Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia Fj Newcombe
- Division of Anaesthesia, Department of Medicine, 2152University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, 25809The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, 112085Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- 89239Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, 7938University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, 5506Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, 7938University 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, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - James D Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, 12235University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, 31031Balgrist University Hospital, Zurich, Switzerland
| | - Mark R N Kotter
- Department of Neurosurgery, 2152University of Cambridge, Cambridge, UK
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25
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Toci G, Canseco J, Karamian B, Chang M, Grasso G, Nicholson K, Pflug E, Russo G, Tarazona D, Kaye ID, Kurd M, Hilibrand A, Woods B, Rihn J, Anderson DG, Radcliff K, Kepler C, Vaccaro A, Schroeder G. The impact of preoperative neurological symptom severity on postoperative outcomes in cervical spondylotic myelopathy. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:94-100. [PMID: 35386246 PMCID: PMC8978848 DOI: 10.4103/jcvjs.jcvjs_165_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/03/2022] [Indexed: 11/16/2022] Open
Abstract
Study Design: The study design is a retrospective cohort study. Objective: To compare patient-reported outcomes between patients with mild versus moderate-to-severe myelopathy following surgery for cervical spondylotic myelopathy (CSM). Summary of Background Data: Recent studies have demonstrated that decompression for CSM leads to improved quality of life when measured by patient-reported outcomes. However, it is unknown if preoperative myelopathy classification is predictive of superior postoperative improvements. Materials and Methods: A retrospective review of patients treated surgically for CSM at a single institution from 2014 to 2015 was performed. Preoperative myelopathy severity was classified according to the modified Japanese Orthopaedic Association (mJOA) scale as either mild (≥15) or moderate-to-severe (<15). Other outcomes included neck disability index (NDI), 12-item short-form survey (SF-12), and visual analog scale (VAS) for arm and neck pain. Differences in outcomes were tested by linear mixed-effects models followed by pairwise comparisons using least square means. Multiple linear regression determined whether any baseline outcomes or demographics predicted postoperative mJOA. Results: There were 67 patients with mild and 50 patients with moderate-to-severe myelopathy. Preoperatively, patients with moderate-to-severe myelopathy reported significantly worse outcomes compared to the mild group for NDI, Physical Component Score (PCS-12), and VAS arm (P = 0.031). While both groups experienced improvements in NDI, PCS-12, VAS Arm and Neck after surgery, only the moderate-to-severe patients achieved improved mJOA (+3.1 points, P < 0.001). However, mJOA was significantly worse in the moderate-to-severe when compared to the mild group postoperatively (-1.2 points, P = 0.017). Both younger age (P = 0.017, β-coefficient = −0.05) and higher preoperative mJOA (P < 0.001, β-coefficient = 0.37) predicted higher postoperative mJOA. Conclusions: Although patients with moderate-to-severe myelopathy improved for all outcomes, they did not achieve normal absolute neurological function, indicating potential irreversible spinal cord changes. Early surgical intervention should be considered in patients with mild myelopathy if they seek to prevent progressive neurological decline over time.
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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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27
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Zaldivar-Jolissaint JF, Lechanoine F, Krummenacher B, Arruda RF, Bobinski L, Schlichting ED, Duff JM. Using Smartphones for Clinical Assessment in Cervical Spondylotic Myelopathy a Feasibility Study. J Med Device 2021; 15:044503. [DOI: 10.1115/1.4052609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 07/20/2021] [Indexed: 11/08/2022] Open
Abstract
Abstract
Degenerative cervical myelopathy (DCM) is characterized by a progressive deterioration in spinal cord function. Its evaluation requires subjective clinical examination with wide interobserver variability. Objective quantification of spinal cord function remains imprecise, even though validated myelopathy-grading scales have emerged and are now widely used. We created a Smartphone Application, the N-Outcome App, with the aim of quantifying accurately and reliably spinal cord dysfunction using a 5-minute Test. A patient suffering from DCM was clinically evaluated before surgery, at 3 and 6 months follow-up after surgical decompression of the cervical spinal cord. Standard scores (Nurick grade, modified Japanese Orthopedic Association (mJOA) score) were documented at these time points. A 5-minute motor and proprioceptive performance test aided by a smartphone with the N-outcome App was also performed. Motor performance in rapid alternating movements and finger tapping improved in correlation with improvements in standard grading scale scores. Clinical improvements were seen in maximum reflex acceleration and in Romberg testing which showed less closed/open eyes variation, suggesting pyramidal and proprioceptive function recovery. We demonstrate that using the N-Outcome App as an adjunct to clinical evaluation of compressive myelopathy is feasible and potentially useful. The results correlate with the results of clinical assessment obtained by standard validated myelopathy scores.
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Affiliation(s)
| | - François Lechanoine
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble 38000, France
| | | | - Rivus Ferreira Arruda
- Department of Neurosurgery, Hospital Universitário Onofre Lopes, Natal 59012-300, Brazil
| | - Lukas Bobinski
- Department of Orthopedic Surgery, Spine Unit, University Hospital of Umea, Umea 907 37, Sweden
| | - Emmanuel de Schlichting
- Service de Neurochirurgie, Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble 38000, France
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Jentzsch T, Cadotte DW, Wilson JR, Jiang F, Badhiwala JH, Akbar MA, Rocos B, Grossman RG, Aarabi B, Harrop JS, Fehlings MG. Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients. J Clin Med 2021; 10:4778. [PMID: 34682902 PMCID: PMC8537526 DOI: 10.3390/jcm10204778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 12/16/2022] Open
Abstract
Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005-2017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p < 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31-3.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28-0.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16-0.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.
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Affiliation(s)
- Thorsten Jentzsch
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - David W. Cadotte
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Combined Spine Program, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, St. Michael’s Hospital, University Health Network, Toronto, ON M5T 2S8, Canada
| | - Fan Jiang
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Muhammad A. Akbar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Brett Rocos
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Robert G. Grossman
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA;
| | - James S. Harrop
- Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada; (T.J.); (J.R.W.); (F.J.); (J.H.B.); (M.A.A.); (B.R.)
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
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Karim SM, Cadotte DW, Wilson JR, Kwon BK, Jacobs WB, Johnson MG, Paquet J, Bailey CS, Christie SD, Nataraj A, Attabib N, Phan P, McIntosh G, Hall H, Rampersaud YR, Manson N, Thomas KC, Fisher CG, Dea N. Effectiveness of Surgical Decompression in Patients With Degenerative Cervical Myelopathy: Results of the Canadian Prospective Multicenter Study. Neurosurgery 2021; 89:844-851. [PMID: 34382661 DOI: 10.1093/neuros/nyab295] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/09/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Conflicting evidence exists regarding the effectiveness of surgery for degenerative cervical myelopathy (DCM), particularly in mild DCM. OBJECTIVE To prospectively evaluate the impact of surgery on patient-reported outcomes in patients with mild (modified Japanese Orthopaedic Association [mJOA] ≥ 15), moderate (mJOA 12-14), and severe (mJOA < 12) DCM. METHODS Prospective, multicenter cohort study of patients with DCM who underwent surgery between 2015 and 2019 and completed 1-yr follow-up. Outcome measures (mJOA, Neck Disability Index [NDI], EuroQol-5D [EQ-5D], Short Form [SF-12] Physical Component Score [PCS]/Mental Component Score [MCS], numeric rating scale [NRS] neck, and arm pain) were assessed at 3 and 12 mo postoperatively and compared to baseline, stratified by DCM severity. Changes in outcome measures that were statistically significant (P < .05) and met their respective minimum clinically important differences (MCIDs) were deemed clinically meaningful. Responder analysis was performed to compare the proportion of patients between DCM severity groups who met the MCID for each outcome measure. RESULTS The cohort comprised 391 patients: 110 mild, 163 moderate, and 118 severe. At 12 mo after surgery, severe DCM patients experienced significant improvements in all outcome measures; moderate DCM patients improved in mJOA, NDI, EQ-5D, and PCS; mild DCM patients improved in EQ-5D and PCS. There was no significant difference between severity groups in the proportion of patients reaching MCID at 12 mo after surgery for any outcome measure, except NDI. CONCLUSION At 12 mo after surgery, patients with mild, moderate, and severe DCM all demonstrated improved outcomes. Severe DCM patients experienced the greatest breadth of improvement, but the proportion of patients in each severity group achieving clinically meaningful changes did not differ significantly across most outcome measures.
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Affiliation(s)
- S Mohammed Karim
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada
| | - David W Cadotte
- University of Calgary Combined Spine Program, Departments of Neuroscience, Neurosurgery and Radiology, Hotchkiss Brain Institute, Calgary, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Brian K Kwon
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada
| | - W Bradley Jacobs
- University of Calgary Combined Spine Program, Departments of Neuroscience, Neurosurgery and Radiology, Hotchkiss Brain Institute, Calgary, Canada
| | - Michael G Johnson
- Department of Surgery, Section of Orthopaedics and Neurosurgery, University of Manitoba, Winnipeg, Canada
| | - Jérôme Paquet
- Centre de Recherche CHU de Quebec, CHU de Quebec-Universite Laval, Quebec City, Canada
| | - Christopher S Bailey
- Division of Orthopaedics, Western University, London Health Science Centre, London, Canada
| | - Sean D Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Andrew Nataraj
- Division of Neurosurgery, Department of Surgery, University of Alberta Hospital, Edmonton, Canada
| | - Najmedden Attabib
- Canada East Spine Centre, Division of Neurosurgery, Zone 2, Horizon Health Network, Saint John, Canada
| | | | - Greg McIntosh
- Canadian Spine Outcomes and Research Network, Markdale, Canada
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Canada
| | - Y Raja Rampersaud
- Division of Orthopaedic Surgery and Neurosurgery, University of Toronto, Toronto, Canada
| | - Neil Manson
- Canada East Spine Centre, Saint John Orthopedics, Dalhousie Medicine New Brunswick, Saint John Campus, Saint John, Canada
| | - Kenneth C Thomas
- University of Calgary Combined Spine Program, Departments of Neuroscience, Neurosurgery and Radiology, Hotchkiss Brain Institute, Calgary, Canada
| | - Charles G Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, Canada
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Wang TY, Than KD. Commentary: Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes. Neurosurgery 2021; 89:E221-E222. [PMID: 34320192 DOI: 10.1093/neuros/nyab263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Timothy Y Wang
- Department of Neurological Surgery, Duke University, Durham, North Carolina, USA
| | - Khoi D Than
- Department of Neurological Surgery, Duke University, Durham, North Carolina, USA
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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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Paliwal M, Weber KA, Smith AC, Elliott JM, Muhammad F, Dahdaleh NS, Bodurka J, Dhaher Y, Parrish TB, Mackey S, Smith ZA. Fatty infiltration in cervical flexors and extensors in patients with degenerative cervical myelopathy using a multi-muscle segmentation model. PLoS One 2021; 16:e0253863. [PMID: 34170961 PMCID: PMC8232539 DOI: 10.1371/journal.pone.0253863] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background In patients with degenerative cervical myelopathy (DCM) that have spinal cord compression and sensorimotor deficits, surgical decompression is often performed. However, there is heterogeneity in clinical presentation and post-surgical functional recovery. Objectives Primary: a) to assess differences in muscle fat infiltration (MFI) in patients with DCM versus controls, b) to assess association between MFI and clinical disability. Secondary: to assess association between MFI pre-surgery and post-surgical functional recovery. Study design Cross-sectional case control study. Methods Eighteen patients with DCM (58.6 ± 14.2 years, 10 M/8F) and 25 controls (52.6 ± 11.8 years, 13M/12 F) underwent 3D Dixon fat-water imaging. A convolutional neural network (CNN) was used to segment cervical muscles (MFSS- multifidus and semispinalis cervicis, LC- longus capitis/colli) and quantify MFI. Modified Japanese Orthopedic Association (mJOA) and Nurick were collected. Results Patients with DCM had significantly higher MFI in MFSS (20.63 ± 5.43 vs 17.04 ± 5.24, p = 0.043) and LC (18.74 ± 6.7 vs 13.66 ± 4.91, p = 0.021) than controls. Patients with increased MFI in LC and MFSS had higher disability (LC: Nurick (Spearman’s ρ = 0.436, p = 0.003) and mJOA (ρ = -0.399, p = 0.008)). Increased MFI in LC pre-surgery was associated with post-surgical improvement in Nurick (ρ = -0.664, p = 0.026) and mJOA (ρ = -0.603, p = 0.049). Conclusion In DCM, increased muscle adiposity is significantly associated with sensorimotor deficits, clinical disability, and functional recovery after surgery. Accurate and time efficient evaluation of fat infiltration in cervical muscles may be conducted through implementation of CNN models.
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Affiliation(s)
- Monica Paliwal
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
- * E-mail:
| | - Kenneth A. Weber
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Andrew C. Smith
- Department of Physical Medicine and Rehabilitation, School of Medicine, Physical Therapy Program, Aurora, Colorado, United States of America
| | - James M. Elliott
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, St. Leonards, New South Wales, Australia
| | - Fauziyya Muhammad
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
| | - Nader S. Dahdaleh
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, Oklahoma, United States of America
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, United States of America
| | - Yasin Dhaher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America
| | - Todd B. Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Sean Mackey
- Department of Anesthesiology, Systems Neuroscience and Pain Laboratory, Perioperative and Pain Medicine, Stanford University, Palo Alto, California, United States of America
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States of America
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Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. Lancet 2021; 397:2082-2097. [PMID: 34062143 DOI: 10.1016/s0140-6736(21)00393-7] [Citation(s) in RCA: 817] [Impact Index Per Article: 272.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 07/08/2020] [Accepted: 07/29/2020] [Indexed: 12/19/2022]
Abstract
Chronic pain exerts an enormous personal and economic burden, affecting more than 30% of people worldwide according to some studies. Unlike acute pain, which carries survival value, chronic pain might be best considered to be a disease, with treatment (eg, to be active despite the pain) and psychological (eg, pain acceptance and optimism as goals) implications. Pain can be categorised as nociceptive (from tissue injury), neuropathic (from nerve injury), or nociplastic (from a sensitised nervous system), all of which affect work-up and treatment decisions at every level; however, in practice there is considerable overlap in the different types of pain mechanisms within and between patients, so many experts consider pain classification as a continuum. The biopsychosocial model of pain presents physical symptoms as the denouement of a dynamic interaction between biological, psychological, and social factors. Although it is widely known that pain can cause psychological distress and sleep problems, many medical practitioners do not realise that these associations are bidirectional. While predisposing factors and consequences of chronic pain are well known, the flipside is that factors promoting resilience, such as emotional support systems and good health, can promote healing and reduce pain chronification. Quality of life indicators and neuroplastic changes might also be reversible with adequate pain management. Clinical trials and guidelines typically recommend a personalised multimodal, interdisciplinary treatment approach, which might include pharmacotherapy, psychotherapy, integrative treatments, and invasive procedures.
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Affiliation(s)
- Steven P Cohen
- Johns Hopkins School of Medicine, Baltimore, MD, USA; Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Lene Vase
- Neuroscientific Division, Department of Psychology and Behavioural Sciences, Aarhus University Hospital, Aarhus, Denmark
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Therapeutic repetitive Transcranial Magnetic stimulation (rTMS) for neurological dysfunction in Degenerative cervical Myelopathy: An unexplored opportunity? Findings from a systematic review. J Clin Neurosci 2021; 90:76-81. [PMID: 34275584 DOI: 10.1016/j.jocn.2021.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 01/18/2023]
Abstract
Degenerative Cervical Myelopathy (DCM) is one of the commonest causes of non-traumatic Spinal Cord Injury (SCI) leading to significant neurological impairments and reduced health-related quality of life. Guidelines recommend surgical intervention to halt disease progression in moderate-to-severe cases, and whilst many do experience neurological recovery, this is incomplete leading to lifelong disability. A James Lind Alliance (JLA) research priority setting partnership for DCM highlighted novel therapies and rehabilitation as top 10 research priority in DCM. Neurological recovery following decompressive surgery in DCM has been attributed neuroplasticity, and therapies influencing neuroplasticity are of interest. Electrical neuromodulation interventions such as repetitive Transcranial Magnetic Stimulation (rTMS), are being increasingly explored in related fields such as spinal cord injury to improve recovery and symptoms. The aim of this systematic review was to determine the role and efficacy of rTMS as a therapeutic tool in managing neurological dysfunction in DCM. We searched the databases of Medline, EMBASE, CINAHIL and Cochrane Central Register of Controlled Trials (CENTRAL). No studies were identified that had investigated the therapeutic use of rTMS in DCM. A significant number of studies had explored TMS based neurophysiological assessments indicating its role as a screening and prognostication tool in DCM. Post-operative rehabilitation interventions including TMS and non-operative management of DCM is a field which requires further investigation, as required in the AO Spine JLA DCM research priorities. rTMS is a safe neuromodulatory intervention and may have a role in enhancing recovery in DCM. Further research in these fields are required.
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Abstract
Spondylotic myelopathies are among the most common disorders of the spine, yet the clinical and treatment approach is far from standardized. This article discusses our current understanding of the epidemiology, pathophysiology, clinical assessment, natural history, and treatment options in degenerative myelopathies of the cervical and thoracic spine. We additionally review diagnostic modalities including imaging modalities of the spine and neurophysiological tools such as electromyography/nerve conduction studies, somatosensory-evoked potentials, and motor-evoked potentials. Assessment instruments that can be used for the assessment of myelopathies are reviewed, including the Japanese Orthopedic Association (JOA) score, modified-JOA scale, Nurick scale, nine-hole peg test, and 30-m walking test. We also review common disorders that mimic spondylotic myelopathies, as well as helpful diagnostic clues in differentiating spondylotic and nonspondylotic myelopathies.
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Affiliation(s)
- Ligia V Onofrei
- Department of Neurology, University of Utah, Salt Lake City, UT
| | - A Michael Henrie
- Department of Physical Medicine and Rehabilitation, University of Utah, UT
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36
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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: 70] [Impact Index Per Article: 23.3] [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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37
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Fiori R, Forcina M, Di Donna C, Spiritigliozzi L, Cavallo AU, Floris R. Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis. Neuroradiol J 2021; 34:313-319. [PMID: 33678063 DOI: 10.1177/19714009211000622] [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: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. MATERIAL AND METHODS Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3-0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5-C6, C6-C7 and C4-C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. RESULTS Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.
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Affiliation(s)
- Roberto Fiori
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Marco Forcina
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Carlo Di Donna
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Luigi Spiritigliozzi
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Armando Ugo Cavallo
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Roberto Floris
- Division of Radiology, University Hospital Policlinico 'Tor Vergata', Italy.,Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
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Oshima Y, Nagata K, Nakamoto H, Sakamoto R, Takeshita Y, Ohtomo N, Kawamura N, Iizuka M, Ono T, Nakajima K, Higashikawa A, Yoshimoto T, Fujii T, Tanaka S, Oka H, Matsudaira K. Validity of the Japanese core outcome measures index (COMI)-neck for cervical spine surgery: a prospective cohort study. 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; 30:402-409. [PMID: 33211189 DOI: 10.1007/s00586-020-06657-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/07/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate the psychometric properties of the Japanese version of the Core Outcome Measures Index-Neck (COMI-Neck) in patients undergoing cervical spine surgery. METHODS A total of 177 patients undergoing cervical spine surgery for spinal disorders from April to December 2017 were enrolled. Patient-reported outcomes (PROs) included EuroQOL, Neck Disability Index, and treatment satisfaction. To address whether the questionnaire's scores relate to other outcomes based on a predefined hypothesis, the correlations between the COMI-Neck and the other PROs were measured (Spearman's rank correlation coefficients). The minimum clinically important difference (MCID) of the COMI summary score was calculated using the receiver operating characteristic (ROC) curve with a 7-point Likert scale of satisfaction with the treatment results. To assess reproducibility, another group of 59 volunteers with chronic neck pain were asked to reply to the COMI-Neck twice with an interval of 7-14 days. RESULTS The COMI summary score showed no floor or ceiling effects preoperatively or postoperatively. Each of the COMI domains and the COMI summary score correlated to the hypothesized extent with the scores of the reference questionnaires (ρ = 0.40-0.79). According to the ROC curve with satisfaction (including "very satisfied" and "satisfied"), the area under the curve and MCID of the COMI summary score were 0.78 and 2.1. The intraclass correlation coefficient and the minimum detectable change (MDC 95%) of the COMI summary score were 0.97 and 0.77. CONCLUSION The Japanese version of the COMI-Neck is valid and reliable for Japanese-speaking patients with cervical spinal disorders.
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Affiliation(s)
- Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,University of Tokyo Spine Group (UTSG), Tokyo, Japan.
| | - Kosei Nagata
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Yujiro Takeshita
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Orthopedic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naohiro Kawamura
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Masaaki Iizuka
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Takashi Ono
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Akiro Higashikawa
- University of Tokyo Spine Group (UTSG), Tokyo, Japan.,Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Takahiko Yoshimoto
- Department of Hygiene, Public Health and Preventive Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Tomoko Fujii
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and Management for Musculoskeletal Pain, Faculty of Medicine, 22nd Century Medical and Research Center, The University of Tokyo, Tokyo, Japan
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Magnetization Transfer Ratio and Morphometrics of the Spinal Cord Associates with Surgical Recovery in Patients with Degenerative Cervical Myelopathy. World Neurosurg 2020; 144:e939-e947. [PMID: 33010502 DOI: 10.1016/j.wneu.2020.09.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES We assessed the prognostic value of the preoperative magnetization transfer ratio (MTR) and morphometrics of the spinal cord in patients with degenerative cervical myelopathy (DCM) in a longitudinal cohort study. METHODS Thirteen subjects with DCM underwent 3T magnetization transfer imaging. The MTR was calculated for the spinal cord regions and specific white matter tracts. Morphometric measures were extracted. Clinical (modified Japanese Orthopaedics Association [mJOA] and Nurick scale scores) and health-related quality of life scores were assessed before and after cervical decompression surgery. The association between the magnetic resonance imaging (MRI) metrics and postoperative recovery was assessed (Spearman's correlation). Receiver operating characteristics were used to assess the accuracy of MRI metrics in identifying ≥50% recovery in function. RESULTS Preoperative anterior cord MTRs were associated with recovery in mJOA scores (ρ = 0.608; P = 0.036; area under the curve [AUC], 0.66). Preoperative lateral cord MTR correlated with the neck disability index (ρ = 0.699; P = 0.011) and pain interference scale (ρ = 0.732; P = 0.007). Preoperative rubrospinal tract MTR was associated with mJOA score recovery (ρ = 0.573; P = 0.041; AUC, 0.86). Preoperative corticospinal tract and reticulospinal MTRs were related to recovery in pain interference scores (ρ = 0.591; P = 0.033; and ρ = 0.583; P = 0.035, respectively). Eccentricity of the cord was associated with Nurick scores (ρ = 0.606; P = 0.028) and mJOA scores (ρ = 0.651; P = 0.025; AUC, 0.92). CONCLUSIONS Preoperative MTR and eccentricity measurements of the spinal cord have prognostic value in assessing the response to surgery and recovery in patients with DCM. Advanced MRI and atlas-based postprocessing techniques can inform interventions and advance the healthcare received by patients with DCM.
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Zipser CM, Pfender N, Spirig JM, Betz M, Aguirre J, Hupp M, Farshad M, Curt A, Schubert M. Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study. BMJ Open 2020; 10:e037332. [PMID: 32958488 PMCID: PMC7507854 DOI: 10.1136/bmjopen-2020-037332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression. METHODS AND ANALYSIS Twenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt's) CSFP-findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging. ETHICS AND DISSEMINATION The study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT02170155).
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Affiliation(s)
- Carl Moritz Zipser
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Nikolai Pfender
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Miguel Spirig
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Michael Betz
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Jose Aguirre
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
- Department of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland
| | - Markus Hupp
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Mazda Farshad
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Armin Curt
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Martin Schubert
- Department of Neurology and Neurophysiology, Balgrist University Hospital, Zurich, Switzerland
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Resting-state Amplitude of Low-frequency Fluctuation is a Potentially Useful Prognostic Functional Biomarker in Cervical Myelopathy. Clin Orthop Relat Res 2020; 478:1667-1680. [PMID: 32011371 PMCID: PMC7310516 DOI: 10.1097/corr.0000000000001157] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Cervical MRI is the standard diagnostic imaging technique for patients with cervical myelopathy. However, the utility of conventional cervical MRI as a predictive biomarker for surgical recovery remains unclear, partly because of the limited information obtained from this anatomically small area. Brain resting-state functional MRI (rs-fMRI) may help identify candidate predictive biomarkers. Two analytical methods that assess local spontaneous brain activity are widely used for rs-fMRI: functional connectivity between two brain regions and amplitude of low-frequency fluctuation (ALFF). In our previous analysis of functional connectivity, we discovered that brain functional connectivity may be a predictive biomarker for neurologic recovery in patients with cervical myelopathy; however, the functional connectivity analysis identified a correlation with only one clinical outcome (the 10-second test). To establish a comprehensive prediction measure, we need to explore other brain biomarkers that can predict recovery of other clinical outcomes in patients with cervical myelopathy. QUESTIONS/PURPOSES We aimed to (1) elucidate preoperative ALFF alterations in patients with cervical myelopathy and how ALFF changes after surgery, with a focus on postoperative normalization and (2) establish a predictive model using preoperative ALFF by investigating the correlation between preoperative ALFF and postoperative clinical recovery in patients with cervical myelopathy. METHODS Between August 2015 and June 2017, we treated 40 patients with cervical myelopathy. Thirty patients met our prespecified inclusion criteria, all were invited to participate, and 28 patients opted to do so (93%; 14 men and 14 women; mean age: 67 years). The 28 patients and 28 age- and sex-matched controls underwent rs-fMRI (twice for patients with cervical myelopathy: before and 6 months after cervical decompression surgery). We analyzed the same study population that was used in our earlier study investigating functional connectivity. Controls had none of the following abnormalities: neck or arm pain, visual or auditory disorders, cognitive disorder, structural brain disorder, a history of brain surgery, mental and neurologic disorders, and medications for the central nervous system. We performed ALFF comparisons between preoperative patients with cervical myelopathy and controls, analyzed postoperative ALFF changes in patients with cervical myelopathy, and performed a correlation analysis between preoperative ALFF and clinical recovery in these patients. Clinical outcomes in the cervical myelopathy group were assessed using the 10-second test, the Japanese Orthopaedic Association upper-extremity motor (JOA-UEM) score, JOA upper-extremity sensory score (JOA-UES), and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire for upper-extremity function (JOACMEQ-UEF) score before and 6 months after surgery, which is when we believe these scores generally reach a plateau. A total of 93% of those enrolled (26 of 28 patients) were analyzed both preoperatively and postoperatively; the other two were lost to follow-up. RESULTS The cervical myelopathy group had an increase in ALFF in the bilateral primary sensorimotor cortices (right, cluster size = 850 voxels, t-value = 6.10; left, cluster size = 370 voxels, t-value = 4.84) and left visual cortex (cluster size = 556 voxels, t-value = 4.21) compared with the control group. The cervical myelopathy group had a decrease in ALFF in the bilateral posterior supramarginal gyrus (right, cluster size = 222 voxels, t-value = 5.09; left, cluster size = 436 voxels, t-value = 5.28). After surgery, the bilateral sensorimotor cortices (right, cluster size = 468 voxels, t-value = 6.74; left, cluster size = 167 voxels, t-value = 5.40) and left visual cortex (cluster size = 3748 voxels, t-value = 6.66) showed decreased ALFF compared with preoperative ALFF, indicating postoperative normalization of spontaneous brain activities in these regions. However, the bilateral posterior supramarginal gyrus did not show an increase in ALFF postoperatively, although ALFF in this region decreased preoperatively. Greater levels of ALFF at the left and right frontal pole and left pars opercularis of the inferior frontal gyrus before surgery in the cervical myelopathy group were correlated with larger improvements in the JOACMEQ-UEF score 6 months after surgery (r = 0.784; p < 0.001, r = 0.734; p < 0.001 and r = 0.770, respectively; p < 0.001). The prediction formula, based on preoperative ALFF values in the left frontal pole, was as follows: the predicted postoperative improvement in the JOACMEQ-UEF score = 34.6 × preoperative ALFF value - 7.0 (r = 0.614; p < 0.001). CONCLUSIONS Our findings suggest that preoperative ALFF may be a biomarker for postoperative recovery in that it predicted postoperative JOACMEQ-UEF scores. To establish a comprehensive prediction measure for neurologic recovery in patients with cervical myelopathy, a multicenter study is underway. LEVEL OF EVIDENCE Level II, diagnostic study.
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Effectiveness of Surgical Treatment for Degenerative Cervical Myelopathy in Preventing Falls and Fall-related Neurological Deterioration: A Prospective Multi-institutional Study. Spine (Phila Pa 1976) 2020; 45:E631-E638. [PMID: 31809466 DOI: 10.1097/brs.0000000000003355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective multi-center study. OBJECTIVE The aim of this study was to evaluate the effectiveness of surgical treatment in reducing falls and fall-related neurological deterioration in a prospective cohort of patients undergoing surgery for degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Current evidence is limited for the effectiveness of surgical interventions for DCM in reducing the risk of fall-related neurological deterioration. METHODS Patients with DCM scheduled for surgical treatment were enrolled prospectively at eight participating institutes. At the time of enrollment, participants were given diaries to record details of their falls, to be returned at the 1-year postoperative follow-up. In the fall diary, patients were asked whether they had experienced any deterioration in neurological symptoms at each fall episode. Deterioration of neurological symptoms was categorized as follows: only deterioration of sensory function in the limbs; or deterioration of motor deficits. The incidence rate of falls was calculated separately for the preoperative and postoperative periods, as the total number of falls divided by the time over which falls were monitored (100 person-years). Functional outcome was assessed with the Japanese Orthopaedic Association (JOA) score and Neck Disability Index. RESULTS Of the initial 168 participants, 159 completed the 1-year follow-up, and 132 fall diaries were retrieved and analyzed. Of these 132 patients, 65 (49%) reported at least one fall during the survey period. The incidence rate of falls decreased significantly from 497.4 to 90.3 falls per 100 person-years after surgery. The incidence of motor deterioration per fall decreased significantly from 34% to 8% after surgery. Patients who experienced preoperative fall-related motor deterioration had a significantly lower JOA score compared with patients without fall-related motor deterioration at 1-year follow-up. CONCLUSION Surgical intervention for DCM is effective not only in reducing the frequency of falls, but also in reducing the risk of fall-related deterioration of motor deficits. LEVEL OF EVIDENCE 2.
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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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Abstract
Tandem spinal stenosis (TSS) refers to simultaneous narrowing of noncontiguous regions of the spinal canal, typically the cervical and lumbar region. Symptomatic TSS may be present in more than 10% of patients presenting with spinal symptoms secondary to stenosis in any one region. Clinical presentation may present challenges because of a mixture of upper and lower motor neuron lesions that can confuse and mislead the clinician. Stenosis at another level may only be detected late, when there is failure to improve after treatment, and, if not detected, can result in either poor treatment outcomes or catastrophic complications. There is no uniform agreement in the management of TSS, and the reported surgical strategies include both simultaneous and staged approaches with each having positive and negative features. This article aims to provide the reader with details on the prevalence, evaluation, and guidance in treatment strategy for TSS.
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Cheng YS, Chien A, Lai DM, Lee YY, Cheng CH, Wang SF, Chang YJ, Wang JL, Hsu WL. Perturbation-Based Balance Training in Postoperative Individuals With Degenerative Cervical Myelopathy. Front Bioeng Biotechnol 2020; 8:108. [PMID: 32154235 PMCID: PMC7044125 DOI: 10.3389/fbioe.2020.00108] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common aging condition caused by spinal cord compression. Individuals with DCM often presented with residual balance and functional impairments postoperatively. Perturbation-based balance training (PBT) has been shown to have positive effects on populations with neurological disorders but has yet to be investigated in DCM. The objective of this study was therefore to evaluate the effects of PBT on balance and functional performance in postoperative individuals with DCM. Fifteen postoperative individuals with DCM (DCM group) and 14 healthy adults (healthy control group) were recruited. The DCM group received a 4-weeks PBT using a perturbation treadmill. The outcome measures included mean velocity of center of pressure (COP) during quiet standing; center of mass (COM) variance and reaction time to balance perturbation during standing with forward and backward perturbation; gait speed during level ground walking; Timed Up and Go Test (TUG) and disability questionnaire scores including Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted pre- and post-training postoperatively for the DCM group but only once for the healthy control group. Significant improvements were observed in the mean velocity of COP, COM variance, reaction time, gait speed, and TUG in the DCM group. Disability questionnaire scores were not significantly different after training in DCM group. For between-group comparisons, significant differences that were observed pre-training were not observed post-training. The 4-weeks PBT is a potential rehabilitation strategy for addressing balance and functional impairment in postoperative individuals with DCM. In addition, the post-training performance in the DCM group exhibited trends comparable to those of age-matched healthy controls. Furthermore, the training regimens offer a practical reference for future studies on populations with balance disorders. Future studies complemented with neurophysiological assessments could reveal more information of the underlying mechanisms of PBT.
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Affiliation(s)
- Yi-Shan Cheng
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Andy Chien
- Department of Physical Therapy, Graduate Institute of Rehabilitation Science, China Medical University, Taichung, Taiwan
| | - Dar-Ming Lai
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Yun Lee
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsiu Cheng
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shwu-Fen Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Ya-Ju Chang
- School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jaw-Lin Wang
- Department of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
| | - Wei-Li Hsu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
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Huang Y, Zhang J, Xiong B, Huang R, Zhao W, Zhou M, Chen Q, Xu D, Chen X. Thunder-fire moxibustion for cervical spondylotic radiculopathy: Study protocol for a randomized controlled trial. Trials 2020; 21:143. [PMID: 32029008 PMCID: PMC7006377 DOI: 10.1186/s13063-019-4012-1] [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] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/19/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Thunder-fire moxibustion originated in China and contains traditional Chinese medicine. It can produce strong firepower, infrared thermal radiation, and medicinal effects when burning on the acupoints. Thunder-fire moxibustion is commonly used in patients with neck pain, but its efficacy has rarely been systematically demonstrated. We designed a randomized trial of thunder-fire moxibustion on cervical spondylotic radiculopathy (CSR) to investigate whether it is more effective than ibuprofen sustained-release capsules. METHODS One hundred patients will be recruited and randomly divided into thunder-fire moxibustion and ibuprofen groups. The intervention consists of ten treatments and will last for 2 weeks. The Yasuhisa Tanaka 20 Score Scale is used as the primary outcome measure. It contains a combination of the self-conscious symptom in patients, objective clinical evaluation from doctors, and social evaluation (the ability to work and live). The objective and comprehensive evaluation of CSR patients before and after treatment is particularly needed. The Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), Neck Disability Index score scale (NDI), and the Quality of Life Assessment (SF-36) are applied as secondary outcome measures. The assessment will take place at the baseline and the first and second weekends of treatment. If an adverse event (AEs) occurs, it will be reported. DISCUSSION The aim of this trial is to determine whether thunder-fire moxibustion is more effective than ibuprofen in the treatment of patients with CSR. TRIAL REGISTRATION Chinese Clinical Trial Registry (http://www.chictr.org.cn), ChiCTR1800018820. Registered on 11 October 2018.
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Affiliation(s)
- Yunxuan Huang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China
| | - Jiabi Zhang
- Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China
| | - Buhui Xiong
- Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China
| | - Ruina Huang
- The Eighth Affiliated Hospital of Sun Yat-sen University, No. 3025 Shennan Middle Road, Futian District, Shenzhen, 518033, China
| | - Wenjing Zhao
- Shenzhen Pingle Orthopaedic Hospital, No.252 Hangzi Section, Pingshan Avenue, Pingshan District, Shenzhen, 518118, China
| | - Mengxue Zhou
- Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Qi Chen
- Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China
| | - Danghan Xu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China.
| | - Xinghua Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No.12 Ji Chang Road, Baiyun District, Guangzhou, 510405, China.
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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: 240] [Impact Index Per Article: 60.0] [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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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: 7] [Impact Index Per Article: 1.8] [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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Bond M, McIntosh G, Fisher C, Jacobs B, Johnson M, Bailey CS, Christie S, Charest-Morin R, Paquet J, Nataraj A, Cadotte D, Wilson J, Manson N, Hall H, Thomas K, Rampersaud YR, Dea N. Treatment of Mild Cervical Myelopathy: Factors Associated With Decision for Surgical Intervention. Spine (Phila Pa 1976) 2019; 44:1606-1612. [PMID: 31205181 DOI: 10.1097/brs.0000000000003124] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective Cohort OBJECTIVE.: The aim of this study was to evaluate which demographic, clinical, or radiographic factors are associated with selection for surgical intervention in patients with mild cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA Surgery has not been shown superior to best conservative management in mild CSM comparative studies; trials of conservative management represent an acceptable alternative to surgical decompression. It is unknown what patients benefit from surgery. METHODS This is a prospective study of patients with mild CSM, defined as modified Japanese Orthopaedic Association Score (mJOA) ≥15. Patients were recruited from seven sites contributing to the Canadian Spine Outcomes Research Network. Demographic, clinical, radiographic and health related quality of life data were collected on all patients at baseline. Multivariate logistic regression modeling was used to identify factors associated with surgical intervention. RESULTS There were 122 patients enrolled, 105 (86.0%) were treated surgically, and 17 (14.0%) were treated nonoperatively. Overall mean age was 54.8 years (SD 12.6) with 80 (65.5%) males. Bivariate analysis revealed no statistically significant differences between surgical and nonoperative groups with respect to age, sex, BMI, smoking status, number of comorbidities and duration of symptoms; mJOA scores were significantly higher in the nonoperative group (16.8 [SD 0.99] vs. 15.9 [SD 0.89], P < 0.001). There was a statistically significant difference in Neck Disability Index, SF12 Physical Component, SF12 Mental Component Score, EQ5D, and PHQ-9 scores between groups; those treated surgically had worse baseline questionnaire scores (P < 0.05). There was no difference in radiographic parameters between groups. Multivariable analysis revealed that lower quality of life scores on EQ5D were associated with selection for surgical management (P < 0.018). CONCLUSION Patients treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to baseline demographic or radiographic parameters. Patients with worse EQ5D scores had higher odds of surgical intervention. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Michael Bond
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | | | - Charles Fisher
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Bradley Jacobs
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - Michael Johnson
- Department of Surgery, Section of Orthopaedics and Neurosurgery, University of Manitoba, Winnipeg, Manitoba
| | | | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia
| | - Raphaele Charest-Morin
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
| | - Jérome Paquet
- Department of Orthopaedics, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec
| | - Andrew Nataraj
- Division of Neurosurgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - David Cadotte
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - Jeff Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario
| | - Neil Manson
- Canada East Spine Centre, Saint John Regional Hospital, Saint John, New Brunswick
| | - Hamilton Hall
- Department of Surgery, University of Toronto, Toronto, Ontario
| | - Kenneth Thomas
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - Yoga Raja Rampersaud
- Division of Orthopaedic Surgery and Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Dea
- Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, British Columbia
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
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