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Yanez Touzet A, Houhou T, Rahic Z, Kolias A, Yordanov S, Anderson DB, Laufer I, Li M, Grahovac G, Kotter MR, Davies BM. Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study. JMIR Form Res 2024; 8:e56889. [PMID: 38787602 PMCID: PMC11161705 DOI: 10.2196/56889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. OBJECTIVE The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. METHODS A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. RESULTS In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. CONCLUSIONS The criteria from COSMIN provide "very good" quality evidence of the reliability of the MoveMed tests in an adult population living with DCM.
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Affiliation(s)
- Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- MoveMed Ltd., Cambridge, United Kingdom
| | - Tatiana Houhou
- Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Zerina Rahic
- Division of Science, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Angelos Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
- ANAPLASI Rehabilitation Centre, Athens, Greece
- 1st Neurosurgery Department, Henry Dunant Hospital Center, Athens, Greece
| | - Stefan Yordanov
- Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - David B Anderson
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ilya Laufer
- New York University Langone Health, New York, NY, United States
| | - Maggie Li
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Gordan Grahovac
- King's College Hospital, Kings NHS Foundation Trust, Denmark Hill, London, United Kingdom
| | - Mark Rn Kotter
- MoveMed Ltd., Cambridge, United Kingdom
- Department of Clinical Neurosurgery, University of Cambridge, Cambridge, United Kingdom
- Department of Clinical Neurosciences, Ann McLaron Laboratory of Regenerative Medicine, Cambridge, United Kingdom
| | - Benjamin M Davies
- MoveMed Ltd., Cambridge, United Kingdom
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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Jiang Z, Davies B, Zipser C, Margetis K, Martin A, Matsoukas S, Zipser-Mohammadzada F, Kheram N, Boraschi A, Zakin E, Obadaseraye OR, Fehlings MG, Wilson J, Yurac R, Cook CE, Milligan J, Tabrah J, Widdop S, Wood L, Roberts EA, Rujeedawa T, Tetreault L. The Frequency of Symptoms in Patients With a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review. Global Spine J 2024; 14:1395-1421. [PMID: 37917661 DOI: 10.1177/21925682231210468] [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: 11/04/2023] Open
Abstract
STUDY DESIGN Delayed diagnosis of degenerative cervical myelopathy (DCM) is associated with reduced quality of life and greater disability. Developing diagnostic criteria for DCM has been identified as a top research priority. OBJECTIVES This scoping review aims to address the following questions: What is the diagnostic accuracy and frequency of clinical symptoms in patients with DCM? METHODS A scoping review was conducted using a database of all primary DCM studies published between 2005 and 2020. Studies were included if they (i) assessed the diagnostic accuracy of a symptom using an appropriate control group or (ii) reported the frequency of a symptom in a cohort of DCM patients. RESULTS This review identified three studies that discussed the diagnostic accuracy of various symptoms and included a control group. An additional 58 reported on the frequency of symptoms in a cohort of patients with DCM. The most frequent and sensitive symptoms in DCM include unspecified paresthesias (86%), hand numbness (82%) and hand paresthesias (79%). Neck and/or shoulder pain was present in 51% of patients with DCM, whereas a minority had back (19%) or lower extremity pain (10%). Bladder dysfunction was uncommon (38%) although more frequent than bowel (23%) and sexual impairment (4%). Gait impairment is also commonly seen in patients with DCM (72%). CONCLUSION Patients with DCM present with many different symptoms, most commonly sensorimotor impairment of the upper extremities, pain, bladder dysfunction and gait disturbance. If patients present with a combination of these symptoms, further neuroimaging is indicated to confirm the diagnosis of DCM.
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Affiliation(s)
- Zhilin Jiang
- King's College Hospital, NHS Foundation Trust, London, UK
| | | | - Carl Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allan Martin
- Department of Neurosurgery, University of California Davis, Davis, CA, USA
| | - Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Elina Zakin
- Department of Neurology, New York UniversityLangone, New York, NY, USA
| | | | - Michael G Fehlings
- Division of Neurosurgery and Spinal Program, University of Toronto, Toronto, ON, Canada
| | - Jamie Wilson
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Ratko Yurac
- Professor of Orthopedics and Traumatology, University del Desarrollo, Clinica Alemana de Santiago, Santiago, Chile
| | - Chad E Cook
- Duke University Medical Center, Durham, NC, USA
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, USA
| | - Julia Tabrah
- Hounslow and Richmond Community Healthcare, London, UK
| | | | - Lianne Wood
- Nottingham University Hospital, Nottingham, UK
| | | | | | - Lindsay Tetreault
- Department of Neurology, New York UniversityLangone, New York, NY, USA
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Goacher E, Yardanov S, Phillips R, Budu A, Dyson E, Ivanov M, Barton G, Hutton M, Gardner A, Quraishi NA, Grahovac G, Jung J, Demetriades AK, Vergara P, Pereira E, Arzoglou V, Francis J, Trivedi R, Davies BM, Kotter MRN. Cost-effectiveness of surgery for degenerative cervical myelopathy in the United Kingdom. Br J Neurosurg 2024:1-5. [PMID: 38712620 DOI: 10.1080/02688697.2024.2346566] [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: 01/22/2024] [Accepted: 04/18/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord dysfunction worldwide, for which surgery is the mainstay of treatment. At present, there is limited literature on the costs associated with the surgical management of DCM, and none from the United Kingdom (UK). This study aimed to evaluate the cost-effectiveness of DCM surgery within the National Health Service, UK. MATERIALS AND METHODS Incidence of DCM was identified from the Hospital Episode Statistics (HES) database for a single year using five ICD-10 diagnostic codes to represent DCM. Health Resource Group (HRG) data was used to estimate the mean incremental surgery (treatment) costs compared to non-surgical care, and the incremental effect (quality adjusted life year (QALY) gain) was based on data from a previous study. A cost per QALY value of <£30,000/QALY (GBP) was considered acceptable and cost-effective, as per the National Institute for Health and Clinical Excellence (NICE) guidance. A sensitivity analysis was undertaken (±5%, ±10% and ±20%) to account for variance in both the cost of admission and QALY gain. RESULTS The total number of admissions for DCM in 2018 was 4,218. Mean age was 62 years, with 54% of admissions being of working age (18-65 years). The overall estimated cost of admissions for DCM was £38,871,534 for the year. The mean incremental (per patient) cost of surgical management of DCM was estimated to be £9,216 (ranged £2,358 to £9,304), with a QALY gain of 0.64, giving an estimated cost per QALY value of £14,399/QALY. Varying the QALY gain by ±20%, resulted in cost/QALY figures between £12,000 (+20%) and £17,999 (-20%). CONCLUSIONS Surgery is estimated to be a cost-effective treatment of DCM amongst the UK population.
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Affiliation(s)
- Edward Goacher
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
| | - Stefan Yardanov
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Alexandru Budu
- Department of Neurosurgery, University Hospitals Birmingham, Birmingham, UK
| | - Edward Dyson
- Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK
| | - Marcel Ivanov
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Gary Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mike Hutton
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Adrian Gardner
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Nasir A Quraishi
- Centre for Spinal Studies & Surgery, Queen's Medical Centre, Nottingham, UK
| | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Josephine Jung
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andreas K Demetriades
- Edinburgh Spinal Surgery Outcome Studies Group, Department of Neurosurgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Pierluigi Vergara
- Department of Spinal Surgery, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Erlick Pereira
- Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vasileios Arzoglou
- Department of Neurosurgery, Hull University Teaching Hospitals, Hull, UK
| | - Jibin Francis
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Rikin Trivedi
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Mark R N Kotter
- Academic Neurosurgery Unit, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
- WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, University of Cambridge, Cambridge, UK
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Qu Z, Deng B, Sun W, Yang R, Feng H. A Convolutional Neural Network for Automated Detection of Cervical Ossification of the Posterior Longitudinal Ligament using Magnetic Resonance Imaging. Clin Spine Surg 2024; 37:E106-E112. [PMID: 37941120 DOI: 10.1097/bsd.0000000000001547] [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: 04/03/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE We aimed to develop and validate a convolutional neural network (CNN) model to distinguish between cervical ossification of posterior longitudinal ligament (OPLL) and multilevel degenerative spinal stenosis using Magnetic Resonance Imaging (MRI) and to compare the diagnostic ability with spine surgeons. SUMMARY OF BACKGROUND DATA Some artificial intelligence models have been applied in spinal image analysis and many of promising results were obtained; however, there was still no study attempted to develop a deep learning model in detecting cervical OPLL using MRI images. MATERIALS AND METHODS In this retrospective study, 272 cervical OPLL and 412 degenerative patients underwent surgical treatment were enrolled and divided into the training (513 cases) and test dataset (171 cases). CNN models applying ResNet architecture with 34, 50, and 101 layers of residual blocks were constructed and trained with the sagittal MRI images from the training dataset. To evaluate the performance of CNN, the receiver operating characteristic curves of 3 ResNet models were plotted and the area under the curve were calculated on the test dataset. The accuracy, sensitivity, and specificity of the diagnosis by the CNN were calculated and compared with 3 senior spine surgeons. RESULTS The diagnostic accuracies of our ResNet34, ResNet50, and ResNet101 models were 92.98%, 95.32%, and 97.66%, respectively; the area under the curve of receiver operating characteristic curves of these models were 0.914, 0.942, and 0.971, respectively. The accuracies and specificities of ResNet50 and ResNet101 models were significantly higher than all spine surgeons; for the sensitivity, ResNet101 model achieved better values than that of the 2 surgeons. CONCLUSION The performance of our ResNet model in differentiating cervical OPLL from degenerative spinal stenosis using MRI is promising, better results were achieved with more layers of residual blocks applied.
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Affiliation(s)
- Zhe Qu
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Bin Deng
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
| | - Ranran Yang
- Xuzhou Medical University
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Hu Feng
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University
- Xuzhou Medical University
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Matsoukas S, Zipser CM, Zipser-Mohammadzada F, Kheram N, Boraschi A, Jiang Z, Tetreault L, Fehlings MG, Davies BM, Margetis K. Scoping Review with Topic Modeling on the Diagnostic Criteria for Degenerative Cervical Myelopathy. Global Spine J 2024:21925682241237469. [PMID: 38442295 DOI: 10.1177/21925682241237469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
STUDY DESIGN This study is a scoping review. OBJECTIVE There is a broad variability in the definition of degenerative cervical myelopathy (DCM) and no standardized set of diagnostic criteria to date. METHODS We interrogated the Myelopathy.org database, a hand-indexed database of primary clinical studies conducted exclusively on DCM in humans between 2005-2021. The DCM inclusion criteria used in these studies were inputted into 3 topic modeling algorithms: Hierarchical Dirichlet Process (HDP), Latent Dirichlet Allocation (LDA), and BERtopic. The emerging topics were subjected to manual labeling and interpretation. RESULTS Of 1676 reports, 120 papers (7.16%) had well-defined inclusion criteria and were subjected to topic modeling. Four topics emerged from the HDP model: disturbance from extremity weakness and motor signs; fine-motor and sensory disturbance of upper extremity; a combination of imaging and clinical findings is required for the diagnosis; and "reinforcing" (or modifying) factors that can aid in the diagnosis in borderline cases. The LDA model showed the following topics: disturbance to the patient is required for the diagnosis; reinforcing factors can aid in the diagnosis in borderline cases; clinical findings from the extremities; and a combination of imaging and clinical findings is required for the diagnosis. BERTopic identified the following topics: imaging abnormality, typical clinical features, range of objective criteria, and presence of clinical findings. CONCLUSIONS This review provides quantifiable data that only a minority of past studies in DCM provided meaningful inclusion criteria. The items and patterns found here are very useful for the development of diagnostic criteria for DCM.
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Affiliation(s)
- Stavros Matsoukas
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | | | - Najmeh Kheram
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Andrea Boraschi
- The Interface Group, Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Zhilin Jiang
- King's College Hospital NHS Foundation Trust, London, UK
| | - Lindsay Tetreault
- Department of Neurology, Langone Health, Graduate Medical Education, New York University, New York, NY, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto and Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Benjamin M Davies
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mandelli F, Zhang Y, Nüesch C, Ewald H, Aghlmandi S, Halbeisen F, Schären S, Mündermann A, Netzer C. Gait function assessed using 3D gait analysis in patients with cervical spinal myelopathy before and after surgical decompression: a systematic review and meta-analysis. Spine J 2024; 24:406-416. [PMID: 37866484 DOI: 10.1016/j.spinee.2023.09.030] [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: 12/19/2022] [Revised: 09/04/2023] [Accepted: 09/30/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) is the most common cause of cervical spinal cord dysfunction in adults and the result of chronic degenerative changes of the cervical spine. The compression of the spinal cord can lead to ischemia, inflammation, and neuronal apoptosis with a consequent impairment of the neurological function. Gait impairment is one of the most frequent signs of DCM. PURPOSE To investigate the changes in spatio-temporal gait parameters assessed using 3D gait analysis in patients affected by DCM compared with healthy controls and the effect of surgical decompression on these parameters. STUDY DESIGN/SETTING Systematic review and meta-analysis. PATIENT SAMPLE The meta-analysis included 267 patients with DCM and 276 healthy controls. OUTCOME MEASURES Spatio-temporal parameters of gait were assessed. The primary outcome was gait speed; the secondary outcomes were cadence, stride length, step width, stride time, single-limb support time, and double-limb support time. METHODS Studies reporting spatial and/or temporal gait parameters measured using 3D gait analysis in patients with DCM were included. Data sources were Embase, Medline, and the Core Collection of Web of Science. Meta-analyses were performed to investigate the influence of surgical decompression in patients measured before and after surgery as well as to compare gait parameters of patients with DCM with controls. RESULTS Thirteen studies reporting on 267 patients with DCM and 276 healthy controls met the inclusion criteria. Seven studies compared patients with DCM with healthy controls, three studies compared gait in patients with DCM before and after surgical decompression, and three studies performed both comparisons. Compared with healthy controls, patients with DCM had slower gait speed (Standardized Mean Difference (SMD), -1.49; 95% confidence interval (CI) [-1.86; -1.13]; p<.001), lower cadence (SMD, -0.78; 95%CI [-1.00; -0.56]; p<.001), shorter stride length (SMD, -1.27; 95%CI [-1.53, -1.01]; p<.001), greater step width (SMD, 0.98; 95%CI [0.42, 1.54]; p=.003), longer stride time (SMD, 0.77; 95%CI [0.37, 1.16]; p=.009), single-limb support phase (SMD, -0.68; 95%CI [-1.06; -0.29]; p=.011), and double-limb support phase (SMD 0.84; 95%CI [0.35, 1.32]; p=.012). After surgical decompression, patients with DCM showed an improvement in gait speed (SMD, 0.57 (95%CI [0.29; 0.85]; p=.003) and no significant differences in other spatio-temporal parameters. CONCLUSIONS Patients with DCM have clearly different spatio-temporal gait parameters than healthy controls. Gait speed is the only spatio-temporal gait parameter that improves significantly after surgical decompression suggesting that gait speed may be an important clinical outcome parameter in patients with DCM.
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Affiliation(s)
- Filippo Mandelli
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
| | - Yuancheng Zhang
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Hannah Ewald
- University Medical Library, University of Basel, Spiegelgasse 5, Basel, 4051, Switzerland
| | - Soheila Aghlmandi
- Institute for Clinical Epidemiology and Biostatistics, University of Basel, Spitalstrasse 12, Basel, 4056, Switzerland
| | - Florian Halbeisen
- Surgical Outcome Research Center Basel, University Hospital Basel, University Basel, Switzerland
| | - Stefan Schären
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Annegret Mündermann
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland
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Brannigan JFM, Davies BM, Mowforth OD, Yurac R, Kumar V, Dejaegher J, Zamorano JJ, Murphy RKJ, Tripathi M, Anderson DB, Harrop J, Molliqaj G, Wynne-Jones G, Arbatin JJF, Kato S, Ito M, Wilson J, Romelean R, Dea N, Graves D, Tessitore E, Martin AR, Nouri A. Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey. Spinal Cord 2024; 62:51-58. [PMID: 38129661 PMCID: PMC10853067 DOI: 10.1038/s41393-023-00945-8] [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: 04/23/2023] [Revised: 11/28/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVE Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice. METHODS Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC. RESULTS A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text. CONCLUSIONS Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.
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Affiliation(s)
- Jamie F M Brannigan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ratko Yurac
- Spine unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile
- Department of Orthopedic and Traumatology, School of Medicine, University del Desarrollo, Santiago, Chile
| | - Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | - Joost Dejaegher
- Department of Neurosurgery, University Hospitals Leuven, Leuven, KU Leuven, Belgium
| | - Juan J Zamorano
- Spine unit, Department of Orthopedic and Traumatology, Clínica Alemana, Santiago, Chile
| | - Rory K J Murphy
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, Arizona, USA
| | | | - David B Anderson
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - James Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Granit Molliqaj
- Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Guy Wynne-Jones
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - So Kato
- The University of Tokyo Hospital, Tokyo, Japan
| | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Jefferson Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ronie Romelean
- Jayapalan Division of Neurosurgery, Department of Surgery, University Malaya Medical Centre, Petaling Jaya, Kuala Lumpur, Malaysia
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program. Vancouver General Hospital, University of British Columbia, Vancouver, Canada
| | - Daniel Graves
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Enrico Tessitore
- Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | | | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
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Touzet AY, Rujeedawa T, Munro C, Margetis K, Davies BM. Machine Learning and Symptom Patterns in Degenerative Cervical Myelopathy: Web-Based Survey Study. JMIR Form Res 2024; 8:e54747. [PMID: 38271070 PMCID: PMC10853854 DOI: 10.2196/54747] [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: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined. OBJECTIVE This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features. METHODS A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics. RESULTS After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM. CONCLUSIONS Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches.
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Affiliation(s)
| | | | - Colin Munro
- University of Cambridge, Cambridge, United Kingdom
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9
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Davies BM, Banerjee A, Mowforth OD, Kotter MRN, Newcombe VFJ. Is the type and/or co-existence of degenerative spinal pathology associated with the occurrence of degenerative cervical myelopathy? A single centre retrospective analysis of individuals with MRI defined cervical cord compression. J Clin Neurosci 2023; 117:84-90. [PMID: 37783068 DOI: 10.1016/j.jocn.2023.09.015] [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: 07/23/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Degenerative cervical myelopathy (DCM) arises from spinal degenerative changes injuring the cervical spinal cord. Most cord compression is incidental, referred to as asymptomatic spinal cord compression (ASCC). How and why ASCC differs from DCM is poorly understood. In this paper, we study a local cohort to identify specific types and groups of degenerative pathology more likely associated with DCM than ASCC. METHODS This study was a retrospective cohort analysis (IRB Approval ID: PRN10455). The frequency of degenerative findings between those with ASCC and DCM patients were compared using network analysis, hierarchical clustering, and comparison to existing literature to identify potential subgroups in a local cohort (N = 155) with MRI-defined cervical spinal cord compression. Quantitative measures of spinal cord compression (MSCC and MCC) were used to confirm their relevance. RESULTS ELF (8.7 %, 95 % CI 3.8-13.6 % vs 35.7 %, 95 % CI 27.4-44.0 %) Congenital Stenosis (3.9 %, 95 % CI 0.6-7.3 % vs 25.0 %, 95 % CI 17.5-32.5 %), and OPLL (0.0 %, 95 % CI 0.0-0.0 % vs 3.6 %, 95 % CI 0.3-6.8 %) were more likely in patients with DCM. Comparative network analysis indicated loss of lordosis was associated with ASCC, whilst ELF with DCM. Hierarchical Cluster Analysis indicated four sub-groups: multi-level disc disease with ELF, single-level disc disease without loss of lordosis and OPLL with DCM, and single-level disc disease with loss of lordosis with ASCC. Quantitative measures of cord compression were higher in groups associated with DCM, but similar in patients with single-level disc disease and loss of lordosis. CONCLUSIONS This study identified four subgroups based on degenerative pathology requiring further investigation.
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Affiliation(s)
- Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK.
| | - Arka Banerjee
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, UK
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10
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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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11
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Rujeedawa T, Mowforth O, Kotter M, Davies B. Rapidly Deteriorating Degenerative Cervical Myelopathy Following Ventricular Shunt Revision for Hydrocephalus: Case Report. Interact J Med Res 2023; 12:e48222. [PMID: 37639306 PMCID: PMC10495845 DOI: 10.2196/48222] [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: 04/16/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
A female patient in her early 40s presented with a several-month history of gait unsteadiness and dragging her left leg. She had a background of congenital hydrocephalus, treated with a ventriculoatrial shunt. On examination, she had increased tone and brisk reflexes in the lower limbs and a positive Hoffmann sign. A computed tomography (CT) scan and shunt series x-rays identified hydrocephalus secondary to a disconnected shunt. Magnetic resonance imaging (MRI) of her cervical spine was also performed as part of the workup for her presenting symptoms and demonstrated features compatible with degenerative cervical myelopathy (DCM). The patient subsequently underwent a shunt revision. Following the operation, her walking and hand function deteriorated over a period of several weeks. She consequently underwent an anterior cervical decompression and fusion for DCM, which partially improved her symptoms. The sequence of events suggests that the shunt surgery may have precipitated a worsening of the DCM. Possible explanations include spinal cord injury related to neck extension or hypoperfusion during intubation and general anesthesia or the loss of cerebrospinal fluid cushioning following the reinstitution of effective cerebrospinal fluid shunting. Surgeons should be alert to this possibility and offer prompt surgical intervention for DCM if required.
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Affiliation(s)
- Tanzil Rujeedawa
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Oliver Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mark Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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12
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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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13
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Zonisamide improves Fas/FasL-mediated apoptosis and inflammation in a degenerative cervical myelopathy rat model. Tissue Cell 2023; 81:102024. [PMID: 36669388 DOI: 10.1016/j.tice.2023.102024] [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: 07/09/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023]
Abstract
Degenerative cervical myelopathy (DCM) is a severe condition of the spinal cord caused by chronic compression. However, no studies to date have examined the effects of zonisamide (ZNS) on DCM via the Fas/FasL-mediated pathway. The aim of this study was to investigate the effects of ZNS on a DCM rat model and to explore the potential mechanisms. First, 40 adult Sprague-Dawley rats were used to establish the DCM rat model and were individually divided into four groups: the Sham group, DCM model group (DCM), ZNS group (DCM model rats treated with ZNS, 30 mg/kg/day), and ZNS + CD95 group (DCM model rats treated with ZNS and CD95). Histopathology injury and cell apoptosis, Fas and Fas ligand (FasL) expression and Fas/FasL relative protein levels were detected by hematoxylin and eosin staining, TUNEL assay, and immunofluorescence and western blotting, respectively. The results of our study demonstrated that ZNS could promote motor recovery while reversing histopathological injury and cell apoptosis in DCM rats. Moreover, Iba-1, Fas and FasL expression in DCM rats was decreased, accompanied by a decrease in cleaved caspase-3/caspase-3, cleaved caspase-8/caspase-8, cleaved caspase-9/caspase-9, cleaved caspase-10/caspase-10 and B-cell lymphoma-2 (Bcl-2)/Bcl-2 associated X (Bax) levels. All these results revealed that ZNS attenuates DCM injury in a rat model via the regulation of Fas and FasL signaling. Our study indicated that ZNS had beneficial effects on DCM and thus provided a novel theoretical approach for subsequent academic and clinical research on DCM injury.
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14
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Kurtz RM, Babatunde VD, Schmitt JE, Berger JR, Mohan S. Spinal Cord Sarcoidosis Occurring at Sites of Spondylotic Stenosis, Mimicking Spondylotic Myelopathy: A Case Series and Review of the Literature. AJNR Am J Neuroradiol 2023; 44:105-110. [PMID: 36521966 PMCID: PMC9835907 DOI: 10.3174/ajnr.a7724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 12/23/2022]
Abstract
Sarcoidosis is a multisystem granulomatous disease, with intramedullary spinal cord involvement seen in <1% of cases. This case series illustrates the clinical presentations and imaging findings of 5 patients with intramedullary spinal neurosarcoidosis occurring at sites of spondylotic spinal canal stenosis, which can be indistinguishable from spondylotic myelopathy with cord enhancement. Both entities are most common in middle-aged men and present with weeks to months of motor and sensory symptoms. On imaging, both can have focal spinal cord enhancement and longitudinally extensive signal abnormality centered at or just below the level of spinal canal stenosis. On the basis of our experience, we suggest that in patients with cord enhancement centered at or just below a site of spinal canal stenosis, consideration should be given to chest imaging and lymph node biopsy when applicable, to assess for the possibility of underlying sarcoidosis before surgical decompression.
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Affiliation(s)
- R M Kurtz
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - V D Babatunde
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - J E Schmitt
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
| | - J R Berger
- Neurology (J.R.B.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Mohan
- From the Departments of Radiology (R.M.K., V.D.B., J.E.S., S.M.)
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15
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Ibara T, Matsui R, Koyama T, Yamada E, Yamamoto A, Tsukamoto K, Kaburagi H, Nimura A, Yoshii T, Okawa A, Saito H, Sugiura Y, Fujita K. Screening for degenerative cervical myelopathy with the 10-second grip-and-release test using a smartphone and machine learning: A pilot study. Digit Health 2023; 9:20552076231179030. [PMID: 37312962 PMCID: PMC10259100 DOI: 10.1177/20552076231179030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 05/12/2023] [Indexed: 06/15/2023] Open
Abstract
Objective Early detection and intervention are essential for the mitigation of degenerative cervical myelopathy (DCM). However, although several screening methods exist, they are difficult to understand for community-dwelling people, and the equipment required to set up the test environment is expensive. This study investigated the viability of a DCM-screening method based on the 10-second grip-and-release test using a machine learning algorithm and a smartphone equipped with a camera to facilitate a simple screening system. Methods Twenty-two participants comprising a group of DCM patients and 17 comprising a control group participated in this study. A spine surgeon diagnosed the presence of DCM. Patients performing the 10-second grip-and-release test were filmed, and the videos were analyzed. The probability of the presence of DCM was estimated using a support vector machine algorithm, and sensitivity, specificity, and area under the curve (AUC) were calculated. Two assessments of the correlation between estimated scores were conducted. The first used a random forest regression model and the Japanese Orthopaedic Association scores for cervical myelopathy (C-JOA). The second assessment used a different model, random forest regression, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Results The final classification model had a sensitivity of 90.9%, specificity of 88.2%, and AUC of 0.93. The correlations between each estimated score and the C-JOA and DASH scores were 0.79 and 0.67, respectively. Conclusions The proposed model could be a helpful screening tool for DCM as it showed excellent performance and high usability for community-dwelling people and non-spine surgeons.
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Affiliation(s)
- Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryota Matsui
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Takafumi Koyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Eriku Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiko Yamamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuya Tsukamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Saito
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Yuta Sugiura
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Kanagawa, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Muacevic A, Adler JR. Identification of Degenerative Cervical Myelopathy in the Chiropractic Office: Case Report and a Review of the Literature. Cureus 2022; 14:e30508. [PMID: 36415361 PMCID: PMC9675290 DOI: 10.7759/cureus.30508] [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: 10/20/2022] [Indexed: 12/14/2022] Open
Abstract
Degenerative cervical myelopathy (DCM) is a common cause of spinal cord dysfunction, yet it may be challenging to identify as it presents with variable symptoms. A 62-year-old woman presented to a chiropractor with a three-month exacerbation of neck pain, hand/finger numbness, and torso dysesthesia. She had previously seen primary care, physical therapy, rheumatology, and pain management. Previous cervical magnetic resonance imaging showed moderate cervical canal stenosis; however, previous providers had diagnosed her with radiculopathy and possible carpal tunnel syndrome yet had not requested neurosurgical consultation. On examination, the chiropractor identified sensorimotor deficits, hyperreflexia, and bilateral Hoffman reflexes, and referred the patient to a neurosurgeon for suspected DCM. The neurosurgeon performed an anterior cervical discectomy and fusion from C4-7. The patient's symptoms and disability level improved within two months of follow-up. We identified 11 previous cases in which a chiropractor suspected DCM which was then confirmed by a surgeon. Including the current case (i.e., 12 total), patients were older and mostly male; 50% had neck pain, 92% had hyperreflexia. Chiropractors referred each patient to a surgeon; 83% underwent cervical spine surgery. This case highlights the identification of DCM by a chiropractor and referral for neurosurgical evaluation with a positive outcome. Patients with previously undiagnosed DCM may present to chiropractors with varied symptoms and examination findings. DCM may contraindicate spinal manipulation and instead warrant surgery. Accordingly, chiropractors play a key role in the detection and referral of patients with misdiagnosed or overlooked DCM.
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