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Davies B, Schaefer S, Rafati Fard A, Newcombe V, Sutcliffe M. Finite Element Analysis for Degenerative Cervical Myelopathy: Scoping Review of the Current Findings and Design Approaches, Including Recommendations on the Choice of Material Properties. JMIR BIOMEDICAL ENGINEERING 2024; 9:e48146. [PMID: 38875683 PMCID: PMC11041437 DOI: 10.2196/48146] [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: 04/13/2023] [Revised: 10/31/2023] [Accepted: 02/15/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is a slow-motion spinal cord injury caused via chronic mechanical loading by spinal degenerative changes. A range of different degenerative changes can occur. Finite element analysis (FEA) can predict the distribution of mechanical stress and strain on the spinal cord to help understand the implications of any mechanical loading. One of the critical assumptions for FEA is the behavior of each anatomical element under loading (ie, its material properties). OBJECTIVE This scoping review aims to undertake a structured process to select the most appropriate material properties for use in DCM FEA. In doing so, it also provides an overview of existing modeling approaches in spinal cord disease and clinical insights into DCM. METHODS We conducted a scoping review using qualitative synthesis. Observational studies that discussed the use of FEA models involving the spinal cord in either health or disease (including DCM) were eligible for inclusion in the review. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The MEDLINE and Embase databases were searched to September 1, 2021. This was supplemented with citation searching to retrieve the literature used to define material properties. Duplicate title and abstract screening and data extraction were performed. The quality of evidence was appraised using the quality assessment tool we developed, adapted from the Newcastle-Ottawa Scale, and shortlisted with respect to DCM material properties, with a final recommendation provided. A qualitative synthesis of the literature is presented according to the Synthesis Without Meta-Analysis reporting guidelines. RESULTS A total of 60 papers were included: 41 (68%) "FEA articles" and 19 (32%) "source articles." Most FEA articles (33/41, 80%) modeled the gray matter and white matter separately, with models typically based on tabulated data or, less frequently, a hyperelastic Ogden variant or linear elastic function. Of the 19 source articles, 14 (74%) were identified as describing the material properties of the spinal cord, of which 3 (21%) were considered most relevant to DCM. Of the 41 FEA articles, 15 (37%) focused on DCM, of which 9 (60%) focused on ossification of the posterior longitudinal ligament. Our aggregated results of DCM FEA indicate that spinal cord loading is influenced by the pattern of degenerative changes, with decompression alone (eg, laminectomy) sufficient to address this as opposed to decompression combined with other procedures (eg, laminectomy and fusion). CONCLUSIONS FEA is a promising technique for exploring the pathobiology of DCM and informing clinical care. This review describes a structured approach to help future investigators deploy FEA for DCM. However, there are limitations to these recommendations and wider uncertainties. It is likely that these will need to be overcome to support the clinical translation of FEA to DCM.
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Affiliation(s)
- Benjamin Davies
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Samuel Schaefer
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
| | - Amir Rafati Fard
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Virginia Newcombe
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Michael Sutcliffe
- Department of Engineering, University of Cambridge, Cambridge, United Kingdom
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Hesni S, Baxter D, Saifuddin A. The imaging of cervical spondylotic myeloradiculopathy. Skeletal Radiol 2023; 52:2341-2365. [PMID: 37071191 DOI: 10.1007/s00256-023-04329-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
This review provides a detailed description of the imaging features of cervical spondylotic myelopathy and radiculopathy, with a focus on MRI. Where relevant, we will outline grading systems of vertebral central canal and foraminal stenosis. Whilst post-operative appearances of the cervical spine are outside the scope of this paper, we will touch on imaging features recognised as predictors of clinical outcome and neurological recovery. This paper will serve as a reference for both radiologists and clinicians involved in the care of patients with cervical spondylotic myeloradiculopathy.
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Affiliation(s)
- Susan Hesni
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK.
| | - David Baxter
- Department of Surgery, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital (RNOH), Stanmore, UK
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de Dios E, Laesser M, Björkman-Burtscher IM, Lindhagen L, MacDowall A. MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy. BMC Med Imaging 2023; 23:180. [PMID: 37946139 PMCID: PMC10634168 DOI: 10.1186/s12880-023-01151-x] [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: 02/07/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy. METHODS T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC). RESULTS The SEm was 0.5 mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6 mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5 mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6 mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC = 0.80 [95% CI 0.70-0.87] and ICC = 0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively). CONCLUSIONS This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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Affiliation(s)
- Eddie de Dios
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden.
| | - Mats Laesser
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Bruna stråket 11, Gothenburg, 41345, Sweden
| | - Lars Lindhagen
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Anna MacDowall
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Tachibana N, Doi T, Nakajima K, Nakamoto H, Miyahara J, Nagata K, Nakarai H, Tozawa K, Ohtomo N, Sakamoto R, Kato S, Taniguchi Y, Matsubayashi Y, Tanaka S, Oshima Y. Does Surgical Treatment Affect the Degree of Anxiety or Depression in Patients With Degenerative Cervical Myelopathy? Global Spine J 2023; 13:2479-2487. [PMID: 35349781 PMCID: PMC10538321 DOI: 10.1177/21925682221088549] [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: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES Preoperative mental state has been reported as one of the factors affecting the surgical outcomes of spine surgery, but few studies have examined in detail how patients' mental state is affected by spine surgery. The purpose of this study was to investigate using the Hospital Anxiety and Depression Scale (HADS) whether surgery improves preoperative depression and anxiety in patients with degenerative cervical myelopathy. METHODS We investigated patient-reported outcomes (Mental Component Summary, Physical Component Summary of SF-12 Health Survey, and EQ-5D, Neck Disability Index, JOACMEQ, satisfaction with treatment) and HADS one year after surgery, comparing them before and after surgery between April 2017 and February 2020. Among the cases diagnosed as preoperative anxiety and depression, we additionally compared the patient-reported outcomes based on the presence or absence of postoperative improvement in mental state, having also investigated the correlation between patient-reported outcomes and HADS for sub-analysis. RESULTS Among the 99 patients eligible for inclusion in the present study, we found that patient-reported outcomes and the HADS scores improved significantly after surgery. There was a moderate correlation between the amount of change in HADS-D score before and after surgery and the amount of change in NDI (moderate, r = .41), NRS of neck (moderate, r = .46), and JOACMEQ (cervical spine function; moderate, r = .43, upper extremity function; moderate, r = .41, QOL; moderate, r = .41). CONCLUSIONS We found that surgical treatment for patients with degenerative cervical myelopathy may improve postoperative anxiety and depression as well as other patient-reported outcomes.
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Affiliation(s)
- Naohiro Tachibana
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Miyahara
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Schaefer SD, Davies BM, Newcombe VF, Sutcliffe MP. Could spinal cord oscillation contribute to spinal cord injury in degenerative cervical myelopathy? BRAIN & SPINE 2023; 3:101743. [PMID: 37383476 PMCID: PMC10293319 DOI: 10.1016/j.bas.2023.101743] [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: 02/06/2023] [Revised: 03/20/2023] [Accepted: 04/12/2023] [Indexed: 06/30/2023]
Abstract
Introduction Degenerative Cervical Myelopathy [DCM] is a slow-motion spinal cord injury. Compression and dynamic compression have been considered disease hallmarks. However, this is likely an oversimplification, as compression is more commonly incidental and has only modest correlation to disease severity. MRI studies have recently suggested spinal cord oscillation could play a role. Research question To determine if spinal cord oscillation could contribute to spinal cord injury in degenerative cervical myelopathy. Material and methods A computational model of an oscillating spinal cord was developed from imaging of a healthy volunteer. Using finite element analysis, the observed implications of stress and strain, were measured in the context of a simulated disc herniation. The significance was bench marked by comparison to a more recognised dynamic injury mechanism; a flexion extension model of dynamic compression. Results Spinal cord oscillation altered both compressive and shear strain on the spinal cord. Following initial compression, compressive strain moves from within the spinal cord to the spinal cord surface, whilst shear strain is magnified by 0.1-0.2, depending on the amplitude of oscillation. These orders of magnitude are equivalent to a dynamic compression model. Discussion and conclusion Spinal cord oscillation could significantly contribute to spinal cord damage across DCM. Its repeated occurrence with every heartbeat, draws parallels to the concept of fatigue damage, which could reconcile differing theories on the origins of DCM. This remains hypothetical at this stage, and further investigations are required.
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Laminoplasty is relevant for degenerative cervical spondylolisthesis when there is little risk of postoperative excessive kyphosis during neck flexion. J Clin Neurosci 2023; 111:26-31. [PMID: 36924657 DOI: 10.1016/j.jocn.2023.03.001] [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: 01/11/2023] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Elderly patients with degenerative cervical myelopathy frequently have severe symptoms due to spondylolisthesis. The effectiveness of laminoplasty for degenerative cervical spondylolisthesis (DCS) is an important question. OBJECTIVE The aim of this study is to elucidate factors associated with the outcome of laminoplasty for DCS. METHOD Eighty-nine patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty without instrumented posterior fusion were enrolled. Positive spondylolisthesis was defined as more than 2 mm during neck flexion or extension, from this, 46 DCS cases and 43 non-DCS cases were classified. Radiological parameters, including cervical alignment, balance, range of motion, and slippage along with the Japanese Orthopedic Association (JOA) score, were obtained before and 1 year after surgery. Factors associated with good surgical outcomes for DCS were analyzed using multivariate logistic analysis. RESULTS There were no significant differences in background and preoperative JOA score, but the DCS group recovery rate was significantly less (42% vs 53%). Multivariate logistic analysis revealed only the postoperative C2-7 angle during neck flexion was associated with a favorable outcome for DCS (P = 0.0039, Odds ratio: 1.49, 95% CI: 1.14-1.94). Multivariate regression analysis positively correlated the preoperative C2-7 angle in neutral and during flexion with the postoperative C2-7 angle during flexion. CONCLUSION The major factor related to poor outcome was the magnitude of postoperative kyphotic C2-7 angle during neck flexion. Slippage was not directly related to outcome and postoperative cervical alignment. Caution is recommended for surgeons performing laminoplasty on patients with risk factors for postoperative excessive kyphotic C2-7 angle during flexion.
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Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VFJ, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time. Global Spine J 2022; 12:78S-96S. [PMID: 35174728 PMCID: PMC8859710 DOI: 10.1177/21925682211057546] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. METHODS Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. RESULTS Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. CONCLUSION Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
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Affiliation(s)
| | - Oliver Mowforth
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Genève, Switzerland
| | - Rana S. Dhillon
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia FJ Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James D. Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Baucher G, Taskovic J, Troude L, Molliqaj G, Nouri A, Tessitore E. Risk factors for the development of degenerative cervical myelopathy: a review of the literature. Neurosurg Rev 2021; 45:1675-1689. [PMID: 34845577 DOI: 10.1007/s10143-021-01698-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/19/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022]
Abstract
Degenerative cervical myelopathy (DCM) encompasses various pathological conditions causing spinal cord (SC) impairment, including spondylosis (multiple level degeneration), degenerative disc disease (DDD), ossification of the posterior longitudinal ligament (OPLL), and ossification of the ligamentum flavum (OLF). It is considered the most common cause of SC dysfunction among the adult population. The degenerative phenomena of DDD, spondylosis, OPLL and OLF, is likely due to both inter-related and distinct factors. Age, cervical alignment, and range of motion, as well as congenital factors such as cervical cord-canal mismatch due to congenital stenosis, Klippel-Feil, Ehler-Danlos, and Down syndromes have been previously reported as potential factors of risk for DCM. The correlation between some comorbidities, such as rheumatoid arthritis and movement disorders (Parkinson disease and cervical dystonia) and DCM, has also been reported; however, the literature remains scare. Other patient-specific factors including smoking, participation in contact sports, regular heavy load carrying on the head, and occupation (e.g. astronauts) have also been suggested as potential risk of myelopathy development. Most of the identified DCM risk factors remain poorly studied however. Further researches will be necessary to strengthen the current knowledge on the subject, especially concerning physical labors in order to identify patients at risk and to develop an effective treatment strategy for preventing this increasing prevalent disorder.
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Affiliation(s)
- Guillaume Baucher
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland.
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin Des Bourrely, 13015, Marseille, France.
| | - Jelena Taskovic
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Lucas Troude
- AP-HM, Hôpital Universitaire Nord, Neurochirurgie adulte, Chemin Des Bourrely, 13015, Marseille, France
| | - Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospital, Geneva, Switzerland
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Takeshima Y, Okamoto A, Yokoyama S, Nakagawa I, Nakase H. Unilateral Degenerative Facet Joint Pathology Eliciting Rapidly Progressive Cervical Spondylotic Myelopathy. Cureus 2021; 13:e14238. [PMID: 33959433 PMCID: PMC8093117 DOI: 10.7759/cureus.14238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a common age-related disease, but little is known concerning the impact of cervical facet degeneration in patients suffering from CSM without degenerative cervical spondylolisthesis or cervical instability. We report an instructive case of CSM with rapid neurological deterioration in which unilateral degenerative facet joint pathology at the affected spinal level and impressive radiological findings were observed. A 70-year-old female progressively developed C5 segmental myelopathy without any trauma within a two-week period. Radiological findings revealed C3-4 spinal canal stenosis with the emergence of increased intramedullary signal intensity on T2-weighted magnetic resonance imaging, articular surface damage at the left C3-4 facet joint on computed tomography, and unilateral “facet joint gap” on cervical radiogram, but did not meet the criteria of cervical instability or spondylolisthesis. This case suggests that some types of severe degenerative changes in cervical facet joints may contribute to cervical myelopathy, especially in cases with progressive neurological deterioration.
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Affiliation(s)
| | - Ai Okamoto
- Neurosurgery, Nara Medical University, Kashihara, JPN
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