1
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Zhang B, Du Y, Duan W, Chen Z. Benchmarking Large Language Models for Cervical Spondylosis. JMIR Form Res 2024; 8:e55577. [PMID: 39102674 DOI: 10.2196/55577] [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: 12/17/2023] [Revised: 04/22/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Abstract
Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence.
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Affiliation(s)
- Boyan Zhang
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China
| | - Yueqi Du
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China
| | - Wanru Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China
| | - Zan Chen
- Xuanwu Hospital, Capital Medical University, Beijing, China
- Lab of Spinal Cord Injury and Functional Reconstruction, China International Neuroscience Institute, Beijing, China
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2
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Brockie S, Zhou C, Fehlings MG. Resident immune responses to spinal cord injury: role of astrocytes and microglia. Neural Regen Res 2024; 19:1678-1685. [PMID: 38103231 PMCID: PMC10960308 DOI: 10.4103/1673-5374.389630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/08/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
Spinal cord injury can be traumatic or non-traumatic in origin, with the latter rising in incidence and prevalence with the aging demographics of our society. Moreover, as the global population ages, individuals with co-existent degenerative spinal pathology comprise a growing number of traumatic spinal cord injury cases, especially involving the cervical spinal cord. This makes recovery and treatment approaches particularly challenging as age and comorbidities may limit regenerative capacity. For these reasons, it is critical to better understand the complex milieu of spinal cord injury lesion pathobiology and the ensuing inflammatory response. This review discusses microglia-specific purinergic and cytokine signaling pathways, as well as microglial modulation of synaptic stability and plasticity after injury. Further, we evaluate the role of astrocytes in neurotransmission and calcium signaling, as well as their border-forming response to neural lesions. Both the inflammatory and reparative roles of these cells have eluded our complete understanding and remain key therapeutic targets due to their extensive structural and functional roles in the nervous system. Recent advances have shed light on the roles of glia in neurotransmission and reparative injury responses that will change how interventions are directed. Understanding key processes and existing knowledge gaps will allow future research to effectively target these cells and harness their regenerative potential.
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Affiliation(s)
- Sydney Brockie
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Cindy Zhou
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
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3
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Chengkai L, Junhong L, Zhengya Z, Jiaxiang Z, Fuan W, Fuxin W, Zhiyu Z, Liu S. Association between grip strength and walking pace with incidence of degenerative cervical myelopathy: a UK biobank observational 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 2024:10.1007/s00586-024-08374-8. [PMID: 38980365 DOI: 10.1007/s00586-024-08374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 05/17/2024] [Accepted: 06/14/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE This study investigates the association between handgrip strength, walking pace, and the incidence of degenerative cervical myelopathy (DCM) using the UK Biobank dataset. METHODS We analyzed data from 364,716 UK Biobank participants without prior neurological conditions. Handgrip strength was measured with a dynamometer, and walking pace was self-reported. Cox proportional hazards models assessed hazard ratios (HRs) and 95% confidence intervals (CIs) for DCM development. RESULTS The cohort, with an average age of 56.2 years (SD, 8.1) and 47.4% male, was followed for a median of 12.6 years. During this period, 3,993 participants (1.1%) developed DCM. A significant inverse correlation was found between handgrip strength and DCM incidence (P for trend < 0.001), with decreasing HRs for DCM across quartiles of increasing grip strength: HRs were 0.70 (95% CI: 0.64-0.76), 0.62 (95% CI: 0.57-0.68), and 0.59 (95% CI: 0.54-0.66) for the second, third, and fourth quartiles, respectively. Participants with average or brisk walking paces had a lower DCM risk (HR, 0.55; 95% CI: 0.50-0.61 and HR, 0.48; 95% CI: 0.43-0.54) compared to slow walkers. The greatest risk reduction was in those with both higher handgrip strength and faster pace (HR, 0.39; 95% CI: 0.34-0.44). CONCLUSIONS Handgrip strength and walking pace are inversely associated with DCM incidence, suggesting their potential as cost-effective screening tools for identifying individuals at risk for DCM.
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Affiliation(s)
- Lin Chengkai
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Shenzhen Key Laboratory of Bone Tissue Repair and Translational Research, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Sun Yat-sen University, China
| | - Li Junhong
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhu Zhengya
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Zhou Jiaxiang
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wang Fuan
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Wei Fuxin
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
- Shenzhen Key Laboratory of Bone Tissue Repair and Translational Research, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Sun Yat-sen University, China.
| | - Zhou Zhiyu
- Innovation Platform of Regeneration and Repair of Spinal Cord and Nerve Injury, Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
| | - Shaoyu Liu
- Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, Department of Spinal Surgery, Orthopaedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Lee DH, Lee HR, Riew KD. An Algorithmic Roadmap for the Surgical Management of Degenerative Cervical Myelopathy: A Narrative Review. Asian Spine J 2024; 18:274-286. [PMID: 38146052 PMCID: PMC11065509 DOI: 10.31616/asj.2023.0413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is a leading cause of disability, and its surgical management is crucial for improving patient neurological outcomes. Given the varied presentations and severities of DCM, treatment options are diverse. Surgeons often face challenges in selecting the most appropriate surgical approach because there is no universally correct answer. This narrative review aimed to aid the decision-making process in treating DCM by presenting a structured treatment algorithm. The authors categorized surgical scenarios based on an algorithm, outlining suitable treatment methods for each case. Four primary scenarios were identified based on the number of levels requiring surgery and K-line status: (1) K-line (+) and ≤3 levels, (2) K-line (+) and ≥3 levels, (3) K-line (-) and ≤3 levels, and (4) K-line (-) and ≥3 levels. This categorization aids in determining the appropriateness of anterior or posterior approaches and the necessity for fusion, considering the surgical level and K-line status. The complexity of surgical situations and diversity of treatment methods for DCM can be effectively managed using an algorithmic approach. Furthermore, surgical techniques that minimize the stages and address challenging conditions could enhance treatment outcomes in DCM.
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Affiliation(s)
- Dong-Ho Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hyung Rae Lee
- Department of Orthopaedic Surgery, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu,
Korea
| | - Kiehyun Daniel Riew
- Department of Orthopaedic Surgery, New York-Presbyterian Och Spine Hospital, Columbia University, New York, NY,
USA
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5
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Xu C, Yin M, Mo W. An independent agreement study of modified Pfirrmann grading system for cervical inter-vertebral disc degeneration in cervical spondylotic myelopathy. Br J Neurosurg 2024; 38:260-264. [PMID: 33332167 DOI: 10.1080/02688697.2020.1861431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 11/06/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). For CSM surgery, it is necessary to evaluate preoperative inter-vertebral disc degeneration (IDD) which determines whether to adopt fusion strategy, and postoperative IDD which is one of the main reasons for reoperation. Modified Pfirrmann grading system is commonly used to evaluate IDD. The objective of this study is to evaluate its reliability and reproducibility on cervical IDD in CSM patients, and to explore its clinical application value. METHODS All 165 patients with CSM were enrolled. 6 physicians (3 spine surgeons and 3 radiologists) who have certain clinical experience were selected. They graded cervical inter-vertebral disc according to modified Pfirrmann grading system, we used intra-class correlation coefficient (ICC) and weighted kappa (wκ) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. RESULTS The inter-observer reliability of modified Pfirrmann grading system was excellent with an ICC value of 0.76 and near perfect with wκ value of 0.82. The intra-observer reproducibility of modified Pfirrmann grading system was excellent with ICC values ranging from 0.80 to 0.91, and near perfect with wκ values ranging from 0.83-0.92. CONCLUSION Modified Pfirrmann grading system has excellent inter-observer reliability and intra-observer reproducibility on cervical IDD in CSM. In addition, it indicates a good appliance among spine surgeons and radiologists, clinical and radiological studies applying it should be deemed accurate. Thus, modified Pfirrmann grading system can be widely used as an appropriate instrument in clinical care.
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Affiliation(s)
| | | | - Wen Mo
- Long Hua Hospital, Shanghai, China
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6
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The Essence of Clinical Practice Guidelines for Cervical Spondylotic Myelopathy, 2020. Spine Surg Relat Res 2024; 8:119-132. [PMID: 38618212 PMCID: PMC11007242 DOI: 10.22603/ssrr.2022-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 04/16/2024] Open
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Opara J, Odzimek M. Cervical Spondylotic Myelopathy-Diagnostics and Clinimetrics. Diagnostics (Basel) 2024; 14:556. [PMID: 38473028 DOI: 10.3390/diagnostics14050556] [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: 01/18/2024] [Revised: 02/25/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
Cervical myelopathy is referred to in many ways in the English literature, for example, as cervical spondylotic myelopathy (CSM), spondylotic radiculomyelopathy (SRM) or degenerative cervical myelopathy (DCM). In addition, more frequent occurrences are noted in older adults and to a greater extent in men. The causes of the effects of cervical myelopathy may be the appearance of lesions on the spinal cord, ischemia due to compression of the vertebral artery and repeated micro-injuries during maximal movements-hyperflexion or hyperextension. It is well known that lesions on the spinal cord may occur in a quarter of the population, and this problem is clearly noted in people over 60 years old. The symptoms of SCM develop insidiously, and their severity and side (unilateral or bilateral) are associated with the location and extent of spinal cord compression. Neurological examination most often diagnoses problems in the upper limbs (most often paresis with developing hand muscle atrophy), pyramidal paralysis in one or both lower limbs and disorders in the urinary system. To make a diagnosis of CSM, it is necessary to perform MRI and neurophysiological tests (such as EMG or sensory and/or motor-evoked potentials). The use of appropriately selected scales and specific tests in diagnostics is also crucial. This narrative review article describes the latest knowledge on the diagnosis and clinimetrics of cervical spondylotic myelopathy in adults and provides future directions.
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Affiliation(s)
- Józef Opara
- Department of Physiotherapy, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| | - Martyna Odzimek
- Doctoral School, The Jan Kochanowski University, Żeromskiego 5, 25-369 Kielce, Poland
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University, al. IX Wieków Kielce 19A, 25-516 Kielce, Poland
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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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Fang Y, Li S, Wang J, Zhang Z, Jiang W, Wang C, Jiang Y, Guo H, Han X, Tian W. Diagnostic efficacy of tract-specific diffusion tensor imaging in cervical spondylotic myelopathy with electrophysiological examination validation. 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 2024; 33:1230-1244. [PMID: 38286908 DOI: 10.1007/s00586-023-08111-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/02/2023] [Accepted: 12/17/2023] [Indexed: 01/31/2024]
Abstract
PURPOSE This study aimed to investigate the effectiveness of tract-specific diffusion tensor imaging (DTI) metrics in identifying the responsible segments for neurological dysfunction in cervical spondylotic myelopathy (CSM). METHODS The study encompassed nineteen participants diagnosed with CSM, including 10 males and 9 females. Additionally, a control group consisting of ten healthy caregivers (5 males and 5 females) were recruited with no symptoms and no compressions on magnetic resonance imaging (MRI). All participants underwent a comprehensive physical examination, MRI assessment, and DTI examination conducted by a senior chief physician. Several parameters were collected from the MR images, including the aspect ratio (defined as the anteroposterior diameter / the transverse diameter of the corresponding segment's spinal cord), transverse ratio (defined as the transverse diameter of the corresponding segment's spinal cord / the transverse diameter of the spinal cord at C2/3), and T2 high signal of the spinal cord. Furthermore, quantitative DTI metrics, such as axial diffusivity (AD), mean diffusivity (MD), radial diffusivity (RD), and fractional anisotropy (FA), were calculated using automatic region-of-interest (ROI) analysis for both whole spinal cord column and dorsal column. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic efficacy of the aspect ratio, transverse ratio, and DTI parameters. The area under the curve (AUC), sensitivity, and specificity were calculated. Intraoperative spinal cord electrophysiological examination was performed as the objective measure of spinal cord function during surgery. RESULTS As determined by electrophysiological examination, neurological dysfunction was found in 2 patients due to C3/4 compression, in 10 patients due to C4/5 compression, in 6 patients due to C5/6 compression, and in 1 patient due to C6/7 compression. The modified Japanese Orthopedic Association scale (mJOA) was 12.71 ± 1.55 in the CSM group, with 4.87 ± 0.72 for sensory nerve function and 5.05 ± 1.35 for motor nerve function. For the control group, none of the volunteers had neurological dysfunction. T2 high signal was found at the most stenotic segment in 13 patients of the CSM group. Considering all the cervical segments, the aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) was more capable of determining the responsible segment than transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). AD, MD, and RD were significantly higher while FA was significantly lower in the responsible segment than in the irresponsible segment (P < 0.05). The AUC of DTI-Dorsal column parameters (AD, MD, RD, FA) was larger than the corresponding parameters of the DTI (Whole spinal cord). AD of DTI-Dorsal Column possessed the greatest efficacy (AUC = 0.823, sensitivity = 84.21%, specificity = 77.32%) to determine the responsible segment, larger than AD of DTI-Whole spinal cord (AUC = 0.822, P = 0.001, Sensitivity = 89.47%, Specificity = 77.32%), aspect ratio (AUC = 0.823, P = 0.001, Sensitivity = 68.42%, Specificity = 82.47%) and transverse ratio (AUC = 0.661, P = 0.027, Sensitivity = 68.42%, Specificity = 67.01%). Subgroup analysis revealed that the diagnostic efficacy of DTI and MRI parameters was influenced by cervical spine segment. CONCLUSIONS When considering all cervical segments, AD from the DTI-Dorsal Column exhibited the most significant potential in identifying responsible segments. This potential was found to be superior to that of DTI-Whole spinal cord, aspect ratio, the most stenotic segment, T2 high signals, transverse ratio, motor nerve dysfunction, and sensory nerve dysfunction. The diagnostic effectiveness of both DTI and MRI parameters was notably influenced by the specific cervical spine segment.
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Affiliation(s)
- Yanming Fang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Sisi Li
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Jinchao Wang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Zhenzhen Zhang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Department of Neurological Electrophysiology, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Wen Jiang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Radiology Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China
| | - Yuancheng Jiang
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Hua Guo
- Center for Biomedical Imaging Research, Tsinghua University, Beijing, China
| | - Xiao Han
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
- Beijing Research Institute of Traumatology and Orthopaedics, Beijing, China.
| | - Wei Tian
- Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
- Spine Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
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10
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Fehlings MG, Alvi MA, Evaniew N, Tetreault LA, Martin AR, McKenna SL, Rahimi-Movaghar V, Ha Y, Kirshblum S, Hejrati N, Srikandarajah N, Quddusi A, Moghaddamjou A, Malvea A, Pinto RR, Marco RAW, Newcombe VFJ, Basu S, Strantzas S, Zipser CM, Douglas S, Laufer I, Chou D, Saigal R, Arnold PM, Hawryluk GWJ, Skelly AC, Kwon BK. A Clinical Practice Guideline for Prevention, Diagnosis and Management of Intraoperative Spinal Cord Injury: Recommendations for Use of Intraoperative Neuromonitoring and for the Use of Preoperative and Intraoperative Protocols for Patients Undergoing Spine Surgery. Global Spine J 2024; 14:212S-222S. [PMID: 38526921 DOI: 10.1177/21925682231202343] [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: 03/27/2024] Open
Abstract
STUDY DESIGN Development of a clinical practice guideline following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) process. OBJECTIVE The objectives of this study were to develop guidelines that outline the utility of intraoperative neuromonitoring (IONM) to detect intraoperative spinal cord injury (ISCI) among patients undergoing spine surgery, to define a subset of patients undergoing spine surgery at higher risk for ISCI and to develop protocols to prevent, diagnose, and manage ISCI. METHODS All systematic reviews were performed according to PRISMA standards and registered on PROSPERO. A multidisciplinary, international Guidelines Development Group (GDG) reviewed and discussed the evidence using GRADE protocols. Consensus was defined by 80% agreement among GDG members. A systematic review and diagnostic test accuracy (DTA) meta-analysis was performed to synthesize pooled evidence on the diagnostic accuracy of IONM to detect ISCI among patients undergoing spinal surgery. The IONM modalities evaluated included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), and multimodal neuromonitoring. Utilizing this knowledge and their clinical experience, the multidisciplinary GDG created recommendations for the use of IONM to identify ISCI in patients undergoing spine surgery. The evidence related to existing care pathways to manage ISCI was summarized and based on this a novel AO Spine-PRAXIS care pathway was created. RESULTS Our recommendations are as follows: (1) We recommend that intraoperative neurophysiological monitoring be employed for high risk patients undergoing spine surgery, and (2) We suggest that patients at "high risk" for ISCI during spine surgery be proactively identified, that after identification of such patients, multi-disciplinary team discussions be undertaken to manage patients, and that an intraoperative protocol including the use of IONM be implemented. A care pathway for the prevention, diagnosis, and management of ISCI has been developed by the GDG. CONCLUSION We anticipate that these guidelines will promote the use of IONM to detect and manage ISCI, and promote the use of preoperative and intraoperative checklists by surgeons and other team members for high risk patients undergoing spine surgery. We welcome teams to implement and evaluate the care pathway created by our GDG.
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Affiliation(s)
- 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
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan Evaniew
- Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | | | - Allan R Martin
- Department of Neurological Surgery, University of California, Davis, Davis, CA, USA
| | | | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Yoon Ha
- Department of Neurosurgery, College of Medicine, Yonsei University, Seoul, Korea
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Nader Hejrati
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Nisaharan Srikandarajah
- Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Anahita Malvea
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ricardo Rodrigues Pinto
- Spinal Unit (UVM), Centro Hospitalar Universitário de Santo António, Hospital CUF Trindade, Porto, Portugal
| | - Rex A W Marco
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Virginia F J Newcombe
- Department of Medicine, University Division of Anaesthesia and PACE, University of Cambridge, Cambridge, UK
| | | | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Carl M Zipser
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Sam Douglas
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Ilya Laufer
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Dean Chou
- Department of Neurosurgery, Columbia University, New York, NY, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Illinois Champaign-Urbana, Urbana, IL, USA
| | - Gregory W J Hawryluk
- Department of Neurosurgery, Cleveland Clinic Akron GeneralHospital, Akron, OH, USA
| | | | - Brian K Kwon
- Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
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11
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Wu J, Sun Z, Ge Z, Zhang D, Xu J, Zhang R, Liu X, Zhao Q, Sun H. The efficacy of virtual reality technology for the postoperative rehabilitation of patients with cervical spondylotic myelopathy (CSM): a study protocol for a randomized controlled trial. Trials 2024; 25:133. [PMID: 38374040 PMCID: PMC10877862 DOI: 10.1186/s13063-024-07962-9] [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: 07/27/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Patients with cervical spondylosis myelopathy (CSM) may experience severe neurological dysfunction due to untimely spinal cord compression after surgery. These disorders may lead to sensory and motion disorders, causing considerable psychological distress. Recent studies found that virtual reality (VR) technology can be an effective tool for treating spinal cord injuries. Owing to this discovery, we developed an exploratory research project to investigate the impact of this intervention on the postoperative recovery of patients with CSM. METHODS The purpose of this randomized controlled trial was to evaluate the efficacy of combining VR technology with conventional rehabilitation strategies for the postoperative rehabilitation of patients with CSM. A total of 78 patients will be recruited and randomized to either the conventional rehabilitation group or the group subjected to VR technology combined with conventional rehabilitation strategies. The Japanese Orthopaedic Association (JOA) scale will be the main tool used, and secondary outcomes will be measured via the visual analogue scale (VAS), neck disability index (NDI), and functional MRI (fMRI). The data analysis will identify differences between the intervention and control groups as well as any relationship between the intragroup changes in the functional area of the brain and the subjective scale scores after the intervention. DISCUSSION The aim of this trial is to investigate the effect of VR training on the postoperative rehabilitation of patients with CSM after 12 intervention treatments. Positive and negative outcomes will help us better understand the effectiveness of the intervention and its neural impact. If effective, this study could provide new options for the postoperative rehabilitation of patients with CSM. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2300071544). Registered 17 May 2023, https://www.chictr.org.cn/ .
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Affiliation(s)
- Jiajun Wu
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhongchuan Sun
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Zhichao Ge
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Dong Zhang
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Jianghan Xu
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Rilin Zhang
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Xuecheng Liu
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China
| | - Qing Zhao
- Center of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
| | - Hao Sun
- Department of Spinal Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200437, China.
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12
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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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13
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Tian XN, Zhang L, Liu HR, Zhang XS, Sun YC, Wang Y. Predictive value of magnetic resonance imaging indications of spinal cord swelling for cervical spondylotic myelopathy prognosis. Technol Health Care 2024; 32:151-162. [PMID: 37092193 DOI: 10.3233/thc-220614] [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] [Indexed: 04/25/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is the preferred examination approach for patients with suspected cervical spondylotic myelopathy (CSM). OBJECTIVE To investigate the predictive value of MRI spinal cord swelling on the prognosis of decompression surgery in patients with CSM. METHODS A retrospective analysis of 115 patients with CSM who underwent decompression surgery was performed. According to whether cervical MRI showed spinal cord swelling, they were divided into a spinal cord swelling group and non-swelling group. The Modified Japanese Orthopaedic Association (MJOA) score, MJOA improvement rate and abnormal spinal cord enhancement rate in the two groups were compared before and after surgery. Multiple linear regression was used to analyse the influencing factors of the MJOA improvement rate. RESULTS The time from symptom onset to operation (t= 2.400, p= 0.018) and preoperative MJOA score in the spinal cord swelling group were lower than those in the non-swelling group (t= 3.253, p= 0.002). The body mass index (t= 2.895, p= 0.005), anteroposterior diameter of the spinal canal (t= 4.421, p< 0.001), cross-sectional area (t= 3.136, p= 0.002), postoperative improvement rate (t= 4.277, p< 0.001) and proportion of abnormal enhancement of the spinal cord in the swelling group were higher than those in the non-swelling group (χ2= 3.136, p= 0.002). The preoperative MJOA score in the swelling group was lower than that in the non-swelling group (t= 2.583, p= 0.013). A multivariate linear regression model revealed that age and spinal cord swelling were independent predictors of MJOA score improvement, explaining 33.2% of the total variation. CONCLUSION Patients with CSM with spinal cord swelling have less time from symptoms to surgery, and the degree of preoperative neurological deterioration is more obvious. Spinal cord swelling is an independent predictor of surgical prognosis in patients with CSM.
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Affiliation(s)
- Xiao-Nan Tian
- Department of Computed Tomography Magnetic Resonance Imaging, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Li Zhang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Hong-Ran Liu
- Department of Computed Tomography Magnetic Resonance Imaging, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xue-Song Zhang
- Department of Computed Tomography Magnetic Resonance Imaging, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ying-Cai Sun
- Department of Computed Tomography Magnetic Resonance Imaging, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yong Wang
- Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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14
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Malhotra AK, Shakil H, Harrington EM, Fehlings MG, Wilson JR, Witiw CD. Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis. Spine J 2024; 24:21-31. [PMID: 37302415 DOI: 10.1016/j.spinee.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/10/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is a form of acquired spinal cord compression and contributes to reduced quality of life secondary to neurological dysfunction and pain. There remains uncertainty regarding optimal management for individuals with mild myelopathy. Specifically, owing to lacking long-term natural history studies in this population, we do not know whether these individuals should be treated with initial surgery or observation. PURPOSE We sought to perform a cost-utility analysis to examine early surgery for mild degenerative cervical myelopathy from the healthcare payer perspective. STUDY DESIGN/SETTING We utilized data from the prospective observational cohorts included in the Cervical Spondylotic Myelopathy AO Spine International and North America studies to determine health related quality of life estimates and clinical myelopathy outcomes. PATIENT SAMPLE We recruited all patients that underwent surgery for DCM enrolled in the Cervical Spondylotic Myelopathy AO Spine International and North America studies between December 2005 and January 2011. OUTCOME MEASURES Clinical assessment measures were obtained using the Modified Japanese Orthopedic Association scale and health-related quality of life measures were obtained using the Short Form-6D utility score at baseline (preoperative), 6 months, 12 months and 24 months postsurgery. Cost measures inflated to January 2015 values were obtained using pooled estimates from the hospital payer perspective for surgical patients. METHODS We employed a Markov state transition model with Monte Carlo microsimulation using a lifetime horizon to obtain an incremental cost utility ratio associated with early surgery for mild myelopathy. Parameter uncertainty was assessed through deterministic means using one-way and two-way sensitivity analyses and probabilistically using parameter estimate distributions with microsimulation (10,000 trials). Costs and utilities were discounted at 3% per annum. RESULTS Initial surgery for mild degenerative cervical myelopathy was associated with an incremental lifetime increase of 1.26 quality-adjusted life years (QALY) compared to observation. The associated cost incurred to the healthcare payer over a lifetime horizon was $12,894.56, resulting in a lifetime incremental cost-utility ratio of $10,250.71/QALY. Utilizing a willingness to pay threshold in keeping with the World Health Organization definition of "very cost-effective" ($54,000 CDN), the probabilistic sensitivity analysis demonstrated that 100% of cases were cost-effective. CONCLUSIONS Surgery compared to initial observation for mild degenerative cervical myelopathy was cost-effective from the Canadian healthcare payer perspective and was associated with lifetime gains in health-related quality of life.
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Affiliation(s)
- Armaan K Malhotra
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Husain Shakil
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Erin M Harrington
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Krembil Research Institute, Toronto Western Hospital, 60 Leonard Ave, Toronto, Ontario, M5T 0S8, Canada
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada
| | - Christopher D Witiw
- Division of Neurosurgery, Department of Surgery, University of Toronto, 149 College St, Toronto, Ontario, M5T 1P5, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada; Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M6, Canada.
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15
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Hirai H, Fujishiro T, Nakaya Y, Hayama S, Usami Y, Mizutani M, Nakano A, Neo M. Clinical outcome of surgical management of mild cervical compressive myelopathy based on minimum clinically important difference. Spine J 2024; 24:68-77. [PMID: 37660898 DOI: 10.1016/j.spinee.2023.08.013] [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: 04/26/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Cervical compressive myelopathy (CCM), caused by cervical spondylosis (cervical spondylotic myelopathy [CSM]) or ossification of the posterior longitudinal ligament (OPLL), is a common neurological disorder in the elderly. For moderate/severe CCM, surgical management has been the first-line therapeutic option. Recently, surgical management is also recommended for mild CCM, and a few studies have reported the surgical outcome for this clinical population. Nonetheless, the present knowledge is insufficient to determine the specific surgical outcome of mild CCM. PURPOSE To examine the surgical outcomes of mild CCM while considering the minimum clinically important difference (MCID). STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients who underwent subaxial cervical surgery for CCM caused by CSM and OPLL between 2013 and 2022 were enrolled. OUTCOME MEASURES The Japanese Orthopedic Association score (JOA score) was employed as the clinical outcomes. Based on previous reports, the JOA score threshold to determine mild myelopathic symptoms was set at ≥14.5 points, and the MCID of the JOA score for mild CCM was set at 1 point. METHODS The patients with a JOA score of ≥14.5 points at baseline were stratified into the mild CCM and were examined while considering the MCID. The mild CCM cohort was dichotomized into the improvement group, including the patients with an achieved MCID (JOA score ≥1 point) or with a JOA score of 17 points (full mark) at 1 year postoperatively, and the nonimprovement group, including the others. Demographics, symptomatology, radiographic findings, and surgical procedure were compared between the two groups and studied using the receiver operating characteristic (ROC) curve. RESULTS Of 335 patients with CCM, 43 were stratified into the mild CCM cohort (mean age, 58.5 years; 62.8% male). Among them, 25 (58.1 %) patients were assigned to the improvement group and 18 (41.9 %) were assigned to the nonimprovement group. The improvement group was significantly younger than the nonimprovement group; however, other variables did not significantly differ. ROC curve analysis showed that the optimal cutoff point of the patient's age to discriminate between the improvement and nonimprovement groups was 58 years with an area under the curve of 0.702 (p=.015). CONCLUSIONS In the present study, the majority of patients with mild CCM experienced improvement reaching the MCID of JOA score at 1 year postoperatively. The present study suggests that for younger patients with mild CCM, especially those aged below 58 years, subjective neurological recovery is more likely to be obtained. Meanwhile, the surgery takes on a more prophylactic significance to halt disease progression for older patients. The results of this study can help in the decision-making process for this clinical population.
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Affiliation(s)
- Hiromichi Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Takashi Fujishiro
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan; Department of Orthopedic Surgery, First Towakai Hospital, 2-17, Miyano-machi, Takatsuki, Osaka 569-0081, Japan.
| | - Yoshiharu Nakaya
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Sachio Hayama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Yoshitada Usami
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Masahiro Mizutani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan
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16
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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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17
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Ogden M, Karagedik MI, Ozdemir A, Bulut IU, Erdogan AM, Bakar B. Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study. World Neurosurg 2023; 180:e560-e578. [PMID: 37778625 DOI: 10.1016/j.wneu.2023.09.110] [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: 06/22/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the "bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)" technique in CSM patients. METHODS The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images. RESULTS Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50 ± 3.42, kyphosis angles were -13.34 ± 13.69° and spinal canal areas were 87.11 ± 28.30 mm2. In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94 ± 3.09, kyphosis angles were -15.07 ± 12.78° and spinal canal areas were 149.65 ± 42.57 mm2. A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (P < 0.001). Kyphosis angles were not different (P = 0.198), and no instability was observed in any patient in long-term follow-up. CONCLUSIONS The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.
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Affiliation(s)
- Mustafa Ogden
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey.
| | | | - Alemiddin Ozdemir
- Department of Neurosurgery, Iskenderun State Hospital, Hatay, Turkey
| | - Ibrahim Umud Bulut
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Ahmet Melih Erdogan
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
| | - Bulent Bakar
- Department of Neurosurgery, Kirikkale University, Faculty of Medicine, Kirikkale, Turkey
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18
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Sakthivelnathan V, Somerson JS, Alijanipour P. Clinical Diagnosis of Common Overlapping Shoulder and Cervical Spine Disorders: A Review of Current Evidence. JBJS Rev 2023; 11:01874474-202311000-00006. [PMID: 37976388 DOI: 10.2106/jbjs.rvw.23.00164] [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: 11/19/2023]
Abstract
» Pain in the shoulder is a common orthopaedic complaint that can be caused by shoulder or neck pathologies.» Shoulder and neck pathologies often coexist, among which one may be a predisposing factor for the other.» History, physical examination, and diagnostic injections can be used to discern the cause of shoulder pain and guide treatment.
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Affiliation(s)
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
| | - Pouya Alijanipour
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, Texas
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19
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Levy HA, Karamian BA, Adams AJ, Mao JZ, Canseco JA, Mandel J, Gebeyehu TF, Harlamova D, Bhatt SD, Heinle J, Kaye ID, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Impact of Preoperative Symptom Duration on Patient Outcomes After Posterior Cervical Decompression and Fusion. Global Spine J 2023; 13:2463-2470. [PMID: 35324359 PMCID: PMC10538330 DOI: 10.1177/21925682221087735] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective Cohort Study. OBJECTIVES To determine if decreased preoperative symptom duration is associated with greater clinical improvement in function and myelopathic symptoms after posterior cervical decompression and fusion (PCDF). METHODS All patients over age 18 who underwent primary PCDF for cervical myelopathy or myeloradiculopathy at a single institution between 2014 and 2020 were retrospectively identified. Patient demographics, surgical characteristics, duration of symptoms, and preoperative and postoperative patient reported outcomes measures (PROMs) including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), Visual Analogue Scale (VAS) Neck, VAS Arm, and SF-12 were collected. Univariate and multivariate analyses were performed to compare change in PROMs and minimum clinically important difference achievement (%MCID) between symptom duration groups (< 6 months, 6 months-2 years, > 2 years). RESULTS Preoperative symptom duration groups differed significantly by sex and smoking status. Patients with < 6 months of preoperative symptoms improved significantly in all PROMs. Patients with 6 months-2 years of preoperative symptoms did not improve significantly in mJOA, Physical Component Scores (PCS), or NDI. Patients with > 2 years of symptoms failed to demonstrate significant improvement in mJOA, NDI, or Mental Component Scores (MCS). Univariate analysis demonstrated significantly decreased improvement in mJOA with longer symptom durations. Increased preoperative symptom duration trended toward decreased %MCID for mJOA and MCS. Regression analysis demonstrated that preoperative symptom duration of > 2 years relative to < 6 months predicted decreased improvement in mJOA and NDI and decreased MCID achievement for mJOA and MCS. CONCLUSION Increased duration of preoperative symptoms (> 2 years) before undergoing PCDF was associated with decreased postoperative improvement in myelopathic symptoms.
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Affiliation(s)
- Hannah A. Levy
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander J. Adams
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jennifer Z. Mao
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jenna Mandel
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Teleale F. Gebeyehu
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daria Harlamova
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Shivangi D. Bhatt
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jeremy Heinle
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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20
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Shangguan Z, Chen G, Liu W, Li J. Clinical outcomes of modified versus traditional expansive open-door laminoplasty for cervical spondylotic myelopathy: A single-institution experience. J Orthop Surg (Hong Kong) 2023; 31:10225536231209556. [PMID: 38006252 DOI: 10.1177/10225536231209556] [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] [Indexed: 11/26/2023] Open
Abstract
PURPOSE To compare the surgical outcomes of modified expansive open-door laminoplasty (EOL) (C4-C6) and traditional EOL (C3-C7) in patients with cervical spondylotic myelopathy (CSM). METHODS One hundred and two CSM patients were retrospectively recruited from Fujian Medical University Union Hospital between March 2012 and December 2019. Seventy-one patients with CSM underwent modified EOL, and 31 patients underwent traditional EOL. The primary endpoint was axial symptoms. RESULTS Patients who underwent modified EOL had a significantly lower incidence of axial symptoms (odds ratio: 0.273; 95% confidence interval: 0.184-0.691; p = .002). The length of hospital stay (p = .263), and intraoperative blood loss (p = .402) were not significantly different between the groups. Significantly more postoperative drainage was observed in patients who underwent modified EOL (p < .001), while the cost of hospitalization in patients treated with traditional EOL was higher (p = .011). There were significant differences between modified and traditional EOL for the changes in range of motion (p < .001), modified Japanese Orthopaedic Association score (p = .001), and the Nurick grade (p = .014), while the changes of visual analogue scale (p = .250), and the neck disability index (p = .134) were not significantly different between the groups. CONCLUSION This study found modified EOL may decrease the incidence of axial symptoms in patients with CSM compared to traditional EOL.
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Affiliation(s)
| | - Gang Chen
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Wenge Liu
- Fujian Medical University Union Hospital, Fuzhou, China
| | - Jiandong Li
- Fujian Medical University Union Hospital, Fuzhou, China
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21
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Rodrigues AJ, Schonfeld E, Varshneya K, Stienen MN, Veeravagu A. The Impact of Preoperative Myelopathy on Postoperative Outcomes among Anterior Cervical Discectomy and Fusion Procedures in the Nonelderly Adult Population: A Propensity-Score Matched Study. Asian Spine J 2023; 17:693-702. [PMID: 37226379 PMCID: PMC10460652 DOI: 10.31616/asj.2022.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/28/2022] [Accepted: 01/20/2023] [Indexed: 05/26/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE Anterior cervical discectomy and fusion (ACDF) is a common surgical intervention for patients diagnosed with cervical degenerative diseases with or without myelopathy. A thorough understanding of outcomes in patients with and without myelopathy undergoing ACDF is required because of the widespread utilization of ACDF for these indications. OVERVIEW OF LITERATURE Non-ACDF approaches achieved inferior outcomes in certain myelopathic cases. Studies have compared patient outcomes across procedures, but few have compared outcomes concerning myelopathic versus nonmyelopathic cohorts. METHODS The MarketScan database was queried from 2007 to 2016 to identify adult patients who were ≤65 years old, and underwent ACDF using the international classification of diseases 9th version and current procedural terminology codes. Nearest neighbor propensity-score matching was employed to balance patient demographics and operative characteristics between myelopathic and nonmyelopathic cohorts. RESULTS Of 107,480 patients who met the inclusion criteria, 29,152 (27.1%) were diagnosed with myelopathy. At baseline, the median age of patients with myelopathy was higher (52 years vs. 50 years, p <0.001), and they had a higher comorbidity burden (mean Charlson comorbidity index, 1.92 vs. 1.58; p <0.001) than patients without myelopathy. Patients with myelopathy were more likely to undergo surgical revision at 2 years (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.54-1.73) or are readmitted within 90 days (OR, 1.27; 95% CI, 1.20-1.34). After patient cohorts were matched, patients with myelopathy remained at elevated risk for reoperation at 2 years (OR, 1.55; 95% CI, 1.44-1.67) and postoperative dysphagia (2.78% vs. 1.68%, p <0.001) compared to patients without myelopathy. CONCLUSIONS We found inferior postoperative outcomes at baseline for patients with myelopathy undergoing ACDF compared to patients without myelopathy. Patients with myelopathy remained at significantly greater risk for reoperation and readmission after balancing potential confounding variables across cohorts, and these differences in outcomes were largely driven by patients with myelopathy undergoing 1-2 level fusions.
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Affiliation(s)
- Adrian John Rodrigues
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Ethan Schonfeld
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Kunal Varshneya
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
| | - Martin Nikolaus Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St. Gallen & Medical School of St.Gallen, St. Gallen,
Switzerland
| | - Anand Veeravagu
- Neurosurgery AI Lab & Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA,
USA
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22
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Chang CJ, Liu YF, Hsiao YM, Chang WL, Hsu CC, Liu KC, Huang YH, Yeh ML, Lin CL. Full Endoscopic Spine Surgery for Cervical Spondylotic Myelopathy: A Systematic Review. World Neurosurg 2023; 175:142-150. [PMID: 37169077 DOI: 10.1016/j.wneu.2023.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023. RESULTS The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications. CONCLUSIONS The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
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Affiliation(s)
- Chao-Jui Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yuan-Fu Liu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yu-Meng Hsiao
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Chang Liu
- School of Medicine, Tzu Chi University, Hualien City, Taiwan; Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yi-Hung Huang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan; Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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23
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Yamada E, Fujita K, Watanabe T, Koyama T, Ibara T, Yamamoto A, Tsukamoto K, Kaburagi H, Nimura A, Yoshii T, Sugiura Y, Okawa A. A screening method for cervical myelopathy using machine learning to analyze a drawing behavior. Sci Rep 2023; 13:10015. [PMID: 37340079 DOI: 10.1038/s41598-023-37253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/19/2023] [Indexed: 06/22/2023] Open
Abstract
Early detection of cervical myelopathy (CM) is important for a favorable outcome, as its prognosis is poor when left untreated. We developed a screening method for CM using machine learning-based analysis of the drawing behavior of 38 patients with CM and 66 healthy volunteers. Using a stylus pen, the participants traced three different shapes displayed on a tablet device. During the tasks, writing behaviors, such as the coordinates, velocity, and pressure of the stylus tip, along with the drawing time, were recorded. From these data, features related to the drawing pressure, and time to trace each shape and combination of shapes were used as training data for the support vector machine, a machine learning algorithm. To evaluate the accuracy, a receiver operating characteristic curve was generated, and the area under the curve (AUC) was calculated. Models with triangular waveforms tended to be the most accurate. The best triangular wave model identified patients with and without CM with 76% sensitivity and 76% specificity, yielding an AUC of 0.80. Our model was able to classify CM with high accuracy and could be applied to the development of disease screening systems useful outside the hospital setting.
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Affiliation(s)
- Eriku Yamada
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Takuro Watanabe
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama-shi, Kanagawa, 223-8522, Japan
| | - Takafumi Koyama
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Akiko Yamamoto
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Kazuya Tsukamoto
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Hidetoshi Kaburagi
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Yuta Sugiura
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, 3-14-1 Hiyoshi, Kohoku-ku, Yokohama-shi, Kanagawa, 223-8522, Japan
| | - Atsushi Okawa
- Department of Orthopedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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24
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Lambrechts MJ, Brush PL, Lee Y, Issa TZ, Lawall CL, Syal A, Wang J, Mangan JJ, Kaye ID, Canseco JA, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD. Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy. Spine (Phila Pa 1976) 2023; 48:526-533. [PMID: 36716386 DOI: 10.1097/brs.0000000000004586] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. MATERIALS AND METHODS Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. RESULTS We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. CONCLUSIONS Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.
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Affiliation(s)
- Mark J Lambrechts
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Parker L Brush
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Yunsoo Lee
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Tariq Z Issa
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | | | - Amit Syal
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - Jasmine Wang
- Thomas Jefferson University Medical School, Philadelphia, PA
| | - John J Mangan
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Ian David Kaye
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Jose A Canseco
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alan S Hilibrand
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Alexander R Vaccaro
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Christopher K Kepler
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
| | - Gregory D Schroeder
- Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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25
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Takri T, Mathew RR, Sivadasan A, Raju K, Karuppusami R, Mariappan R. The Utility of COMPASS-31 Questionnaire to Predict Autonomic Dysfunction in Patients With Cervical/Upper Thoracic Compressive Myelopathy. J Neurosurg Anesthesiol 2023; 35:243-247. [PMID: 34873138 DOI: 10.1097/ana.0000000000000824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with cervical/upper thoracic compressive myelopathy may have autonomic dysfunction. The composite autonomic severity score (CASS) is the gold standard test to detect autonomic dysfunction, and the self-rated composite autonomic system scale (COMPASS-31) questionnaire is a screening tool to diagnose autonomic dysfunction. This study compared the COMPASS-31 and modified CASS scores for the detection of autonomic dysfunction in patients with compressive myelopathy. METHODS Patients with cervical/upper thoracic compressive myelopathy scheduled for decompressive surgery completed a COMPASS-31 questionnaire and underwent autonomic function tests to calculate the modified CASS score before surgery. RESULTS Forty-two patients were included in the study; 19 (45.2%) had mild autonomic dysfunction, 5 (11.9%) had moderate autonomic dysfunction, and 18 (42.9%) had severe autonomic dysfunction. Median (interquartile range) of modified CASS and COMPASS-31 scores were 19 (6.33) and 3 (2.5), respectively. There was a positive correlation between modified CASS and COMPASS-31 scores ( r =0.43; P =0.004). Receiver operating characteristic curve analysis confirmed that COMPASS-31 had fair accuracy for prediction of moderate to severe autonomic dysfunction (area under the curve, 0.74; 95% confidence interval, 0.64-0.82; P =0.009). A cut-off of 30 for total COMPASS-31 score had a sensitivity of 52.2% and specificity of 89.5% to detect moderate to severe autonomic dysfunction, with positive and negative predictive values of 85.7% and 60.7%, respectively. CONCLUSION Patients with cervical/upper thoracic compressive myelopathy had varying degrees of autonomic dysfunction based on the modified CASS. There was a positive correlation between the modified CASS and COMPASS-31 questionnaire. A COMPASS-31 score of >30 30 could be utilized to predict moderate to severe autonomic dysfunction in patients with compressive myelopathy.
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26
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White cord syndrome secondary to decompressive laminectomy associated with cervical arthrodesis in a patient with diffuse idiopathic skeletal hyperostosis and posterior longitudinal ligament ossification. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Quantitative physical performance tests can effectively detect Degenerative Cervical Myelopathy: A systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3347-3364. [PMID: 36069938 DOI: 10.1007/s00586-022-07349-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/30/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE This review aimed to identify effective physical performance tests (PPT) as clinical outcome indicators for detecting and monitoring degenerative cervical myelopathy (DCM). METHODS A comprehensive literature search was performed on seven electronic databases on the effectiveness in detection and monitoring of DCM by PPT. All included studies were reviewed and undergone quality assessments on the risk-of-bias by Newcastle-Ottawa Scale and were pooled by random-effect analysis with level of significance at 0.05. Homogeneity among studies was assessed by I2-statistics and effect of PPT was confirmed by Cohen's d effect size and confidence intervals. RESULTS Totally, 3111 articles were retrieved, and 19 studies were included for review and meta-analysis. There were 13 studies investigating PPT regarding the upper limbs and 12 studies regarding the lower limbs. Performance in 10-second-Grip-and-Release Test (G&R) and 9-Hole-Peg Test (9HPT) was studied in 10 and 3 articles, respectively, while 10-second-Stepping Test (SST), 30-meter-Walking Test (30MWT) and Foot-Tapping Test (FTT) for lower limbs were studied in 5, 4, and 3 articles correspondingly. Only 1 study utilized the Triangle-Stepping Test. High-quality study with fair risk-of-bias was revealed from Newcastle-Ottawa scale. Large effect size facilitated detection and monitoring in DCM was unveiling for G&R, 9HPT, SST, and 30MWT. FTT, while also effective, was hindered by a high-degree heterogeneity in the meta-analysis. CONCLUSION Effective PPT including G&R, 9HPT, SST, 30MWT, and FTT was identified for disease detection and monitoring in DCM.
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28
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Chang CJ, Liu YF, Hsiao YM, Huang YH, Liu KC, Lin RM, Lin CL. Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. J Neurosurg Spine 2022; 37:569-578. [PMID: 35453110 DOI: 10.3171/2022.2.spine211500] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/23/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) has long been regarded as a gold standard in the treatment of cervical myelopathy. Subsequently, cervical artificial disc replacement (c-ADR) was developed and provides the advantage of motion preservation at the level of the intervertebral disc surgical site, which may also reduce stress at adjacent levels. The goal of this study was to compare clinical and functional outcomes in patients undergoing ACDF with those in patients undergoing c-ADR for cervical spondylotic myelopathy (CSM). METHODS A systematic literature review and meta-analysis were performed using the Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from database inception to November 21, 2021. The authors compared Neck Disability Index (NDI), SF-36, and Japanese Orthopaedic Association (JOA) scores; complication rates; and reoperation rates for these two surgical procedures in CSM patients. The Mantel-Haenszel method and variance-weighted means were used to analyze outcomes after identifying articles that met study inclusion criteria. RESULTS More surgical time was consumed in the c-ADR surgery (p = 0.04). Shorter hospital stays were noted in patients who had undergone c-ADR (p = 0.04). Patients who had undergone c-ADR tended to have better NDI scores (p = 0.02) and SF-36 scores (p = 0.001). Comparable outcomes in terms of JOA scores (p = 0.24) and neurological success rate (p = 0.12) were noted after the surgery. There was no significant between-group difference in the overall complication rates (c-ADR: 18% vs ACDF: 25%, p = 0.17). However, patients in the ACDF group had a higher reoperation rate than patients in the c-ADR group (4.6% vs 1.5%, p = 0.02). CONCLUSIONS At the midterm follow-up after treatment of CSM, better functional outcomes as reflected by NDI and SF-36 scores were noted in the c-ADR group than those in the ACDF group. c-ADR had the advantage of retaining range of motion at the level of the intervertebral disc surgical site without causing more complications. A large sample size with long-term follow-up studies may be required to confirm these findings in the future.
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Affiliation(s)
- Chao-Jui Chang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yuan-Fu Liu
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 3Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin
| | - Yu-Meng Hsiao
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Yi-Hung Huang
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 5Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City
| | - Keng-Chang Liu
- 6Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi
- 7School of Medicine, Tzu Chi University, Hualien City
| | - Ruey-Mo Lin
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan
| | - Cheng-Li Lin
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 2Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
- 8Musculoskeletal Research Center, Innovation Headquarters, National Cheng Kung University, Tainan; and
- 9Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan
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29
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He YX, Shang QS, Feng L, Li HB, Han L, Zhou D, Jiang YQ. Comparison of the Safety and Efficacy of Three-Dimensional Guiding Templates and Free Hand Technique for Cervical Pedicle Screw Fixation: A Retrospective Study. Surg Innov 2022; 29:652-661. [DOI: 10.1177/15533506221127381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim. To compare the safety and efficacy of computed tomography (CT)-assisted three-dimensional guiding templates (3DGTs) and free-hand (FH) technique for posterior cervical pedicle screw fixation in cervical spondylotic myelopathy (CSM) treatment. Methods. Thirty-five patients (216 screws) with CSM and developmental cervical stenosis were randomly divided into groups A (FH) and B (3DGTs). All patients underwent modified posterior surgery with cervical pedicle screw insertion (C1-7). Preoperative, postoperative, and intergroup comparisons of efficacy were evaluated using the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Short Form 12 (SF-12) scores and JOA score improvement rate. Incidence of intra- and postoperative complications was analyzed. Postoperative cervical spine CT was performed to evaluate (i) the pedicle screws’ deviation angle from the optimal path (sagittal deviation, α; coronal deviation angle, β), screw insertion point’s deviation distance (d), and screw accuracy and (ii) the deviation angle and distance of screw entrance point of pedicle screws from the optimal channel. Results. All patients successfully completed the procedures. Groups A and B did not significantly differ in age, sex ratio, body mass index, operative time, or intraoperative blood loss amount. Postoperative VAS, JOA, and SF-12 scores improved in both groups. VAS, JOA, or SF-12 scores did not significantly differ between the 2 groups. The α, β, and d scores were lower in group B, but accuracy was higher in group B. Conclusions. 3DGTs and FH technique show comparable outcomes with respect to neurological improvement and safety.
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Affiliation(s)
- Yan-xing He
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province
| | - Qi-song Shang
- Department of Orthopedics, Third Affiliated Hospital School of Medicine College, Shihezi City, Xinjiang Province
| | - Lin Feng
- Department of Orthopedics, Wuqia People’s Hospital, The Kirgiz Autonomous Prefecture of Kizilsu, Xinjiang Uygur Autonomous Region
| | - Hai-bo Li
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province
| | - Long Han
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province
| | - Dong Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province
- Department of Orthopedics, Wuqia People’s Hospital, The Kirgiz Autonomous Prefecture of Kizilsu, Xinjiang Uygur Autonomous Region
| | - Yu-qing Jiang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province
- Department of Orthopedics, Wuqia People’s Hospital, The Kirgiz Autonomous Prefecture of Kizilsu, Xinjiang Uygur Autonomous Region
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Kobayashi H, Otani K, Nikaido T, Watanabe K, Kato K, Kobayashi Y, Yabuki S, Konno SI. Development of a Novel Diagnostic Support Tool for Degenerative Cervical Myelopathy Combining 10-s Grip and Release Test and Grip Strength: A Pilot Study. Diagnostics (Basel) 2022; 12:diagnostics12092108. [PMID: 36140509 PMCID: PMC9497574 DOI: 10.3390/diagnostics12092108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/24/2022] Open
Abstract
Early diagnosis of degenerative cervical myelopathy (DCM) is desirable, as delayed treatment can cause irreversible spinal cord injury and subsequent activity of daily living (ADL) impairment. We attempted to develop a straightforward and accurate diagnostic tool for DCM by combining the grip and release test (GRT) and grip strength. As a pilot study, we measured the GRT and grip strength of patients with DCM (n = 247) and a control group (n = 721). Receiver operating characteristic analysis was performed using the lower left and right. The Youden index was used to set cutoff values by sex and age group. The diagnostic performance of each test varied by sex and age, and a diagnostic support tool was created to determine any abnormal results in a test. The calculated M/F cutoff values for GRT were as follows: 40–59 years, 21/18; 60–69 years, 17/17; 70–79 years, 15/15; and 80–89 years, 11/12. The calculated M/F cutoff values for grip strength 32/20, 29/13, 21/15, and 19/10. When either GRT or grip strength was judged as positive, the overall sensitivity was 88.2%, specificity was 78.1%, positive likelihood ratio was 4.03, and the negative likelihood ratio was 0.15. This novel diagnostic support tool was superior to using GRT and grip strength alone in the early DCM diagnosis. Future research to obtain age- and sex-specific data is necessary to validate and further improve the tool.
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Wang DF, Zhu WG, Wang W, Li XY, Kong C, Liu CX, Shi B, Lu SB. The discrepancy between preoperative cervical sagittal vertical axis and T1 slope predisposes inferior clinical outcomes in patients with cervical spondylotic myelopathy after cervical laminoplasty. Front Surg 2022; 9:1003757. [PMID: 36090340 PMCID: PMC9458913 DOI: 10.3389/fsurg.2022.1003757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Cervical sagittal parameters have been widely used to predict clinical outcomes in patients with cervical spondylotic myelopathy (CSM). This study aims to coin a novel cervical sagittal parameter defined as the ratio of cervical sagittal vertical axis to T1 slope (CSVA/T1S) and to investigate the correlation between CSVA/T1S and postoperative HRQOL after laminoplasty. Methods A total of 102 CSM patients treated with cervical laminoplasty from our database were retrospectively reviewed. All patients were followed up for >12 months. Radiological parameters were measured using lateral cervical radiographs, including occiput-C2 lordosis (OC2), cervical lordosis (CL), CSVA, and T1S. Clinical parameters included the Japanese Orthopedic Association (JOA) score, neck disability index (NDI), and JOA recovery rate. Patients were grouped by preoperative T1S, T1S-CL, and CSVA/T1S value, respectively. Clinical and radiological outcomes were compared between the groups. Results Patients with high CSVA/T1S had greater OC2 and CSVA but lower CL than those in the low CSVA/T1S group pre-and postoperatively. With respect to HRQOL results, the final NDI was 12.46 ± 9.11% in the low CSVA/T1S group, which was significantly lower than that in the high CSVA/T1S group (17.68 ± 8.81%, P = 0.040). Moreover, only CSVA/T1S was detected to be significantly correlated with final NDI (r = 0.310, P = 0.027). No significant correlation was found between clinical results and other cervical sagittal parameters, including T1S, CSVA, and T1S-CL. Conclusions Preoperative CSVA/T1S was correlated with postoperative NDI in patients with CSM after cervical laminoplasty. Patients with low preoperative CSVA/T1S achieved better neurological function improvement after cervical laminoplasty. Cervical laminoplasty could be an appropriate choice for patients with lower preoperative CSVA/T1S.
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Affiliation(s)
- Dong-Fan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei-Guo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cheng-Xin Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Shi
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Correspondence: Shi-Bao Lu
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Analysis of Spastic Gait in Patients With Cervical Myelopathy Using the Timed Up and Go Test With a Laser Range Sensor. Spine (Phila Pa 1976) 2022; 47:892-898. [PMID: 34802028 DOI: 10.1097/brs.0000000000004284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE This study aimed to objectively evaluate spastic gait and reveal its novel characteristics via analysis of gait in patients with cervical myelopathy (CM) using the Timed Up and Go (TUG) test with a laser range sensor. SUMMARY OF BACKGROUND DATA Among patients with CM, spastic gait is a common diagnostic symptom; thus, objective assessments of spastic gait would be useful for the diagnosis of CM and recognition of disease status. Although spastic gait has been objectively evaluated in previous studies, the methods employed in those studies are not suitable for clinical settings. METHODS In total, 37 and 24 participants were recruited for a control group and CM group, respectively. CM was diagnosed by spine surgeons. We developed a laser TUG test, in which the position and velocity of both the legs were captured. The parameter values for both groups were statistically compared, and odds ratios were calculated using logistic regression analyses. RESULTS The total TUG-test time, time to stand up, time to first step, number of steps, and trajectory error for the CM group were significantly higher than those for the control group, whereas the average velocity and average stride length for the CM group were significantly lower than those for the control group. There was a significant independent association between the total TUG-test time and CM. The optimal cutoff point of the total test time for CM risk was approximately 9 seconds. CONCLUSION Through the use of the laser TUG test, we were able to identify characteristics of spastic gait, which leads to difficulty in standing and taking the first step, wobbling while walking, and an increased risk of falling. We found that the risk of CM was higher if the individual took longer than 9 seconds to complete the TUG test.Level of Evidence: 4.
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Ogawa T, Yoshii T, Oyama J, Sugimura N, Akada T, Sugino T, Hashimoto M, Morishita S, Takahashi T, Motoyoshi T, Oyaizu T, Yamada T, Onuma H, Hirai T, Inose H, Nakajima Y, Okawa A. Detecting ossification of the posterior longitudinal ligament on plain radiographs using a deep convolutional neural network: a pilot study. Spine J 2022; 22:934-940. [PMID: 35017056 DOI: 10.1016/j.spinee.2022.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/01/2021] [Accepted: 01/03/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Its rare prevalence and subtle radiological changes often lead to difficulties in diagnosing cervical ossification of the posterior longitudinal ligament (OPLL) on plain radiographs. However, OPLL progression may lead to trauma-induced spinal cord injury, resulting in severe paralysis. To address the difficulties in diagnosis, a deep learning approach using a convolutional neural network (CNN) was applied. PURPOSE The aim of our research was to evaluate the performance of a CNN model for diagnosing cervical OPLL. STUDY DESIGN AND SETTING Diagnostic image study. PATIENT SAMPLE This study included 50 patients with cervical OPLL, and 50 control patients with plain radiographs. OUTCOME MEASURES For the CNN model performance evaluation, we calculated the area under the receiver operating characteristic curve (AUC). We also compared the sensitivity, specificity, and accuracy of the diagnosis by the CNN with those of general orthopedic surgeons and spine specialists. METHODS Computed tomography was used as the gold standard for diagnosis. Radiographs of the cervical spine in neutral, flexion, and extension positions were used for training and validation of the CNN model. We used the deep learning PyTorch framework to construct the CNN architecture. RESULTS The accuracy of the CNN model was 90% (18/20), with a sensitivity and specificity of 80% and 100%, respectively. In contrast, the mean accuracy of orthopedic surgeons was 70%, with a sensitivity and specificity of 73% (SD: 0.12) and 67% (SD: 0.17), respectively. The mean accuracy of the spine surgeons was 75%, with a sensitivity and specificity of 80% (SD: 0.08) and 70% (SD: 0.08), respectively. The AUC of the CNN model based on the radiographs was 0.924. CONCLUSIONS The CNN model had successful diagnostic accuracy and sufficient specificity in the diagnosis of OPLL.
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Affiliation(s)
- Takahisa Ogawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
| | - Jun Oyama
- Department of Radiology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Nobuhiro Sugimura
- Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Takashi Akada
- Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Takaaki Sugino
- Department of Biomedical Information, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Motonori Hashimoto
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Shingo Morishita
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takuya Takahashi
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takayuki Motoyoshi
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takuya Oyaizu
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tsuyoshi Yamada
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Onuma
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Hirai
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Inose
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Yoshikazu Nakajima
- Department of Biomedical Information, Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University, Tokyo, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spine Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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Hospitalisation for degenerative cervical myelopathy in England: insights from the National Health Service Hospital Episode Statistics 2012 to 2019. Acta Neurochir (Wien) 2022; 164:1535-1541. [PMID: 35511406 PMCID: PMC9069214 DOI: 10.1007/s00701-022-05219-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction worldwide. However, the current incidence of DCM is poorly understood. The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise surgical activity for DCM in England. METHODS The HES database was interrogated for all cases of DCM between 2012 and 2019. DCM cases were identified from 5 ICD-10 codes. Age-stratified values were collected for 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital admission under a lead clinician. Data was analysed to explore current annual activity and longitudinal change. RESULTS 34,903 FCEs with one or more of the five ICD-10 codes were identified, of which 18,733 (53.6%) were of working age (18-64 years). Mean incidence of DCM was 7.44 per 100,000 (SD ± 0.32). Overall incidence of DCM rose from 6.94 per 100,000 in 2012-2013 to 7.54 per 100,000 in 2018-2019. The highest incidence was seen in 2016-2017 (7.94 per 100,000). The median male number of FCEs per year (2919, IQR: 228) was consistently higher than the median female number of FCEs per year (2216, IQR: 326). The rates of both emergency admissions and planned admissions are rising. CONCLUSIONS The incidence of hospitalisation for DCM in England is rising. Health care policymakers and providers must recognise the increasing burden of DCM and act to address both early diagnoses and access to treatment in future service provision plans.
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Huang T, Zhong W, Lu C, Zhang C, Deng Z, Zhou R, Zhao Z, Luo X. Visualized Analysis of Global Studies on Cervical Spondylosis Surgery: A Bibliometric Study Based on Web of Science Database and VOSviewer. Indian J Orthop 2022; 56:996-1010. [PMID: 35662885 PMCID: PMC9123106 DOI: 10.1007/s43465-021-00581-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study used multiple type of bibliometric analysis for identifying and summarizing the publications regarding cervical spondylosis surgery, for clarifying the history of this field, predicting the future hotspots of this field and improving communication among researchers. METHODS Publications from Web of Science database between 1900 and 2019 were downloaded and analyzed by Excel 2016 and VOSviewer. Bibliometric maps of co-citations and maps of co-occurrence of keywords are constructed by VOSviewer software. RESULTS A total of 2110 publications were searched from Web of Science. The total sum of times cited is 40448 with the average citation per publication of 19.17 times. USA published most papers (652, 30.9%). The most productive organizations is University of Toronto (96 publications). Spine (308 publications) published the most publications in this field. In co-citations of references analysis, four clusters of references are constructed by VOSviewer. In co-occurrence of keywords analysis, three clusters of keywords are constructed by VOSviewer. The latest keyword "degenerative cervical myelopathy" appeared in 2017 in 42 papers. Other relatively new keywords include "surgical outcomes", "association", "sagittal alignment", "prognostic-factors" that appeared in 2016 in 33, 31, 34 and 37 papers respectively. CONCLUSION USA dominates the research regarding cervical spondylosis surgery. University of Toronto is the most productive organization in this field. Spine, European Spine Journal and Journal of Neurosurgery Spine are the top three productive journals on publications of cervical spondylosis surgery. "Degenerative cervical myelopathy", "surgical outcomes", "association", "sagittal alignment" and "prognostic-factors" may be the new research hotspots in this field.
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Affiliation(s)
- Tianji Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Weiyang Zhong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Chao Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Chunyang Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zhongqi Deng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Runtao Zhou
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Zenghui Zhao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
| | - Xiaoji Luo
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016 People’s Republic of China
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Nouri A, Tessitore E, Molliqaj G, Meling T, Schaller K, Nakashima H, Yukawa Y, Bednarik J, Martin AR, Vajkoczy P, Cheng JS, Kwon BK, Kurpad SN, Fehlings MG, Harrop JS, Aarabi B, Rahimi-Movaghar V, Guest JD, Davies BM, Kotter MRN, Wilson JR. Degenerative Cervical Myelopathy: Development and Natural History [AO Spine RECODE-DCM Research Priority Number 2]. Global Spine J 2022; 12:39S-54S. [PMID: 35174726 PMCID: PMC8859703 DOI: 10.1177/21925682211036071] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To discuss the current understanding of the natural history of degenerative cervical myelopathy (DCM). METHODS Literature review summarizing current evidence pertaining to the natural history and risk factors of DCM. RESULTS DCM is a common condition in which progressive arthritic disease of the cervical spine leads to spinal cord compression resulting in a constellation of neurological symptoms, in particular upper extremity dysfunction and gait impairment. Anatomical factors including cord-canal mismatch, congenitally fused vertebrae and genetic factors may increase individuals' risk for DCM development. Non-myelopathic spinal cord compression (NMSCC) is a common phenomenon with a prevalence of 24.2% in the healthy population, and 35.3% among individuals >60 years of age. Clinical radiculopathy and/or electrophysiological signs of cervical cord dysfunction appear to be risk factors for myelopathy development. Radiological progression of incidental Ossification of the Posterior Longitudinal Ligament (OPLL) is estimated at 18.3% over 81-months and development of myelopathy ranges between 0-61.5% (follow-up ranging from 40 to 124 months between studies) among studies. In patients with symptomatic DCM undergoing non-operative treatment, 20-62% will experience neurological deterioration within 3-6 years. CONCLUSION Current estimates surrounding the natural history of DCM, particularly those individuals with mild or minimal impairment, lack precision. Clear predictors of clinical deterioration for those treated with non-operative care are yet to be identified. Future studies are needed on this topic to help improve treatment counseling and clinical prognostication.
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Affiliation(s)
- Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Enrico Tessitore
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Granit Molliqaj
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Torstein Meling
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Karl Schaller
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasutsugu Yukawa
- Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité Universitätsmedizin, Berlin, Germany
| | - Joseph S. Cheng
- Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery and Spine Program, University of Toronto, Ontario, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, FL, USA
| | - Benjamin M. Davies
- Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
| | - Mark R. N. Kotter
- Department of Neurosciences, University of Cambridge, Cambridge, United Kingdom
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, United Kingdom
| | - Jefferson R. Wilson
- Division of Neurosurgery and Spine Program, University of Toronto, Ontario, Canada
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Davies BM, Mowforth O, Wood H, Karimi Z, Sadler I, Tetreault L, Milligan J, Wilson JRF, Kalsi-Ryan S, Furlan JC, Kawaguchi Y, Ito M, Zipser CM, Boerger TF, Vaccaro AR, Murphy RKJ, Hutton M, Rodrigues-Pinto R, Koljonen PA, Harrop JS, Aarabi B, Rahimi-Movaghar V, Kurpad SN, Guest JD, Wilson JR, Kwon BK, Kotter MRN, Fehlings MG. Improving Awareness Could Transform Outcomes in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 1]. Global Spine J 2022; 12:28S-38S. [PMID: 35174734 PMCID: PMC8859708 DOI: 10.1177/21925682211050927] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To introduce the number one research priority for Degenerative Cervical Myelopathy (DCM): Raising Awareness. METHODS Raising awareness has been recognized by AO Spine RECODE-DCM as the number one research priority. This article reviews the evidence that awareness is low, the potential drivers, and why this must be addressed. Case studies of success from other diseases are also reviewed, drawing potential parallels and opportunities for DCM. RESULTS DCM may affect as many as 1 in 50 adults, yet few will receive a diagnosis and those that do will wait many years for it. This leads to poorer outcomes from surgery and greater disability. DCM is rarely featured in healthcare professional training programs and has received relatively little research funding (<2% of Amyotrophic Lateral Sclerosis or Multiple Sclerosis over the last 25 years). The transformation of stroke and acute coronary syndrome services, from a position of best supportive care with occasional surgery over 50 years ago, to avoidable disability today, represents transferable examples of success and potential opportunities for DCM. Central to this is raising awareness. CONCLUSION Despite the devastating burden on the patient, recognition across research, clinical practice, and healthcare policy are limited. DCM represents a significant unmet need that must become an international public health priority.
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Affiliation(s)
- Benjamin M. Davies
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Oliver Mowforth
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Helen Wood
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
| | - Zahabiya Karimi
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
| | - Iwan Sadler
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
| | - Lindsay Tetreault
- Department of Neurology, Langone Health, Graduate Medical Education, New York University, New York, NY, USA
| | - Jamie Milligan
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Jamie R. F. Wilson
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sukhvinder Kalsi-Ryan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Julio C. Furlan
- KITE Research Institute, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | | | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Timothy F Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rory K. J. Murphy
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mike Hutton
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ricardo Rodrigues-Pinto
- Department of Orthopaedics, Spinal Unit (UVM), Centro Hospitalar Universitário Do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paul A. Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - 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
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, 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
| | - Jefferson R. Wilson
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Department of Orthopedics, Vancouver Spine Surgery Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Mark R. N. Kotter
- Myelopathy.org, International Charity for Degenerative Cervical Myelopathy, Cambridge, UK
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
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Cervical Myelopathy Screening with Machine Learning Algorithm Focusing on Finger Motion Using Noncontact Sensor. Spine (Phila Pa 1976) 2022; 47:163-171. [PMID: 34593737 DOI: 10.1097/brs.0000000000004243] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To develop a binary classification model for cervical myelopathy (CM) screening based on a machine learning algorithm using Leap Motion (Leap Motion, San Francisco, CA), a novel noncontact sensor device. SUMMARY OF BACKGROUND DATA Progress of CM symptoms are gradual and cannot be easily identified by the patients themselves. Therefore, screening methods should be developed for patients of CM before deterioration of myelopathy. Although some studies have been conducted to objectively evaluate hand movements specific to myelopathy using cameras or wearable sensors, their methods are unsuitable for simple screening outside hospitals because of the difficulty in obtaining and installing their equipment and the long examination time. METHODS In total, 50 and 28 participants in the CM and control groups were recruited, respectively. The diagnosis of CM was made by spine surgeons. We developed a desktop system using Leap Motion that recorded 35 parameters of fingertip movements while participants gripped and released their fingers as rapidly as possible. A support vector machine was used to develop the binary classification model, and a multiple linear regression analysis was performed to create regression models to estimate the total Japanese Orthopaedic Association (JOA) score and the JOA score of the motor function of the upper extremity (MU-JOA score). RESULTS The binary classification model indexes were as follows: sensitivity, 84.0%; specificity, 60.7%; accuracy, 75.6%; area under the curve, 0.85. The Spearman rank correlation coefficient between the estimated score and the total JOA score was 0.44 and that between the estimated score and the MU-JOA score was 0.51. CONCLUSION Our binary classification model using a machine learning algorithm and Leap Motion could classify CM with high sensitivity and would be useful for CM screening in daily life before consulting doctors and telemedicine.Level of Evidence: 3.
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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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Zakaria Mohamad Z, Sharifudin MA, Din H, Abd Aziz A, Karupiah RK. Correlation Study Between Clinical Special Tests for Myelopathy and Static MRI Parameters in Patients of Malaysian Population Treated for Cervical Dysfunction. Cureus 2021; 13:e18826. [PMID: 34804683 PMCID: PMC8592785 DOI: 10.7759/cureus.18826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Magnetic resonance imaging (MRI) remains the imaging modality of choice, but its findings are not completely specific for clinically significant CSM. This cross-sectional study aims to determine the pathoanatomy of CSM in patients and analyze the correlations between clinical key symptoms, myelopathic signs, and MRI findings. Methods: Patients with CSM aged 30 to 80 years old with no previous cervical spine disease or injuries were recruited. Clinical parameters include myelopathic hand signs and other clinical-specific tests. The MRI findings were analyzed for level of compression, underlying degenerative pathology, and parameters for cord compression. Results: Thirty patients were recruited. The most common myelopathic signs observed were positive Hoffmann’s sign and the presence of reverse brachioradialis reflex. All patients had either degenerative or prolapse disc changes on MRI. There was a positive correlation between the clinical key features with MRI parameters for canal and cord diameter. The transverse cord diameter, cord compression ratio, and approximate cord area were the only independent variables related to almost all the positive clinical specific tests. All three have a moderate to strong correlation with the clinical findings. Conclusion: The MRI parameters such as canal and cord size of the cervical spine are an objective reflection of compression on the spinal cord. Correlations observed indicate cord compression that plays a major role in the pathophysiology of CSM. These measurements are sensitive indicators of canal stenosis and play a significant role in predicting the severity and outcome of CSM.
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Affiliation(s)
- Zamzuri Zakaria Mohamad
- Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Mohd Ariff Sharifudin
- Orthopaedics and Traumatology, Universiti Sultan Zainal Abidin, Kuala Terengganu, MYS
| | - Hishamudin Din
- Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
| | - Azian Abd Aziz
- Radiology, International Islamic University Malaysia, Kuantan, MYS
| | - Rajandra Kumar Karupiah
- Orthopaedics, Traumatology & Rehabilitation, International Islamic University Malaysia, Kuantan, MYS
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Rodríguez Domínguez V, Gandía González ML, García Feijoo P, Sáez Alegre M, Vivancos Sánchez C, Pérez López C, Isla Guerrero A. Treatment of cervical myelopathy by posterior approach: Laminoplasty vs. laminectomy with posterior fixation, are there differences from a clinical and radiological point of view? NEUROCIRUGÍA (ENGLISH EDITION) 2021; 33:284-292. [PMID: 34799283 DOI: 10.1016/j.neucie.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 05/17/2021] [Accepted: 06/18/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cervical degenerative myelopathy is a variable and progressive degenerative disease caused by chronic compression of the spinal cord. Surgical approaches for the cervical spine can be performed anteriorly and/or posteriorly. Regarding the posterior approach, there are 2 fundamental techniques: laminoplasty and laminectomy with posterior fixation (LPF). There is still controversy concerning the technique in terms of outcome and complications. The aim of the present work is to analyze from the clinical and radiological point of view these 2 techniques: laminoplasty and LPF. MATERIALS AND METHODS A historical cohort of 39 patients was reviewed (12 LFP and 27 laminoplasty) including patients operated in a 10 years period at the Hospital Universitario La Paz with a follow-up of 12 months after surgery was carried out. The clinical results were analyzed and compared using the Nurick scale and the modified Japanese Orthopaedic Association Scale (mJOA) and the radiological results using the Cobb angle, Sagittal Vertical Axis, T1 Slope and alignment (measured by Cobb-T1 Sloppe). RESULTS Significant differences were observed in the postoperative improvement of the Nurick scale (p = 0.008) and mJOA (p = 0.018) in the laminoplasty group. In LFP there is a tendency to a greater improvement, but statistical significance is not reached due to the low sample size of this group. No statistically significant differences were observed in the radiological variables. Regarding the total number of complications, a higher number was observed in the laminoplasty group (7 cases) versus LFP (one case), but no statistically significant differences were observed. CONCLUSIONS Laminoplasty and LFP are both safe and effective procedures in the treatment of cervical degenerative myelopathy. The findings of our study demonstrate statistically significant clinical improvement based on the Nurick and mJOA scales with laminoplasty. No significant differences in terms of complications or radiological variables were observed between the 2 techniques.
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Asuzu DT, Yun JJ, Alvi MA, Chan AK, Upadhyaya CD, Coric D, Potts EA, Bisson EF, Turner JD, Knightly JJ, Fu KM, Foley KT, Tumialan L, Shaffrey M, Bydon M, Mummaneni PV, Park P, Meyer S, Asher AL, Gottfried ON, Than KD, Wang MY, Buchholz AL. Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database. J Neurosurg Spine 2021; 36:568-574. [PMID: 34740180 DOI: 10.3171/2021.7.spine21590] [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: 04/24/2021] [Accepted: 07/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. METHODS Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. RESULTS In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). CONCLUSIONS Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.
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Affiliation(s)
- David T Asuzu
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.,2Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jonathan J Yun
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Andrew K Chan
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | | | - Domagoj Coric
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Eric A Potts
- 8Goodman Campbell Brain and Spine, Carmel, Indiana
| | - Erica F Bisson
- 4Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Jay D Turner
- 9Barrow Neurological Institute, Phoenix, Arizona
| | | | - Kai-Ming Fu
- 11Department of Neurological Surgery, Weill Cornell Medicine, New York, New York
| | - Kevin T Foley
- 12Department of Neurosurgery, University of Tennessee, Memphis, Tennessee
| | | | - Mark Shaffrey
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Mohamad Bydon
- 3Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Praveen V Mummaneni
- 5Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Paul Park
- 13Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Scott Meyer
- 10Altair Health Spine and Wellness, Morristown, New Jersey
| | - Anthony L Asher
- 7Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Oren N Gottfried
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Khoi D Than
- 14Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
| | - Michael Y Wang
- 15Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Avery L Buchholz
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Kobayashi H, Otani K, Handa J, Kato K, Watanabe K, Nikaido T, Yabuki S, Konno SI. Development of a self-administered questionnaire for the screening of cervical myelopathy. Part 2, investigation of its characteristics in surgical cases. Fukushima J Med Sci 2021; 67:102-106. [PMID: 34645735 PMCID: PMC8784193 DOI: 10.5387/fms.2021-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Our previous report described the development of a self-administered questionnaire to screen patients for cervical myelopathy (SQC). For clinical application, the characteristics of the SQC should be verified. Methods: Participants comprised 129 patients (94 men, 35 women) with cervical myelopathy who underwent operative treatment. SQC score was calculated before surgery and patients were divided into a positive group (score ≥6) and negative group (score <6). Sex, age, pathologies of cervical myelopathy, Japanese Orthopaedic Association (JOA) score, 10-s grip-and-release test (10-s test), grip strength, number of levels decompressed, most cranial level of damage, and presence of diabetes mellitus (DM) were compared between groups. Results: The sensitivity was 89.9% with 116 positive cases and 13 negative cases (10.1%). JOA score was significantly higher and 10-s test and grip strength significantly better in the negative group than in the positive group. No significant differences in sex, age, pathologies of cervical myelopathy, number of spinal levels decompressed, most rostral level of damage, or presence of DM were seen between groups. Conclusions: Screening for cervical myelopathy using SQC had a high sensitivity of 89.9%. However, SQC should be used with caution because it may miss mild cervical myelopathy with low JOA scores.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Junichi Handa
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kinshi Kato
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Kazuyuki Watanabe
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Takuya Nikaido
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shoji Yabuki
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
| | - Shin-Ichi Konno
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine
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Ibrahim S, Mousa A, Riawan W. Expression of AIF and Caspase-3 in New Zealand rabbit with Cervical Spondylosis Myelopathy model. Ann Med Surg (Lond) 2021; 69:102604. [PMID: 34429943 PMCID: PMC8368771 DOI: 10.1016/j.amsu.2021.102604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Cervical spondylosis myelopathy (CSM) is a clinical syndrome of motoric or sensoric, caused by degenerative process chronically causing narrowing of cervical canal and compressing the spinal cord. The narrowing of canalis spinalis causing chronic compression and disrupting vascular patency in spinal cord. This is worsened on repetitive trauma on flexion, extension and rotation. CSM has an incidence of 4.04 in 100.000 cases per year and the total patients undergoing treatment operative or nonoperatively in year increasing for 7 times. Apoptosis plays a critical role in important biological processes such as morphogenesis, tissue homeostasis, and immunity; furthermore, its aberrant activation or impairment may contribute to a number of diseases. The understanding of CSM pathophysiology from apoptotic pathway is an essential topic to discussed and the treatment of this case in future. Method This study uses experimental study with Post test Only Control Group, using New Zealand rabbits. The rabbits given the compression on cervical as high as C5 to induce CSM. The tissue was taken from spinal cord on compression area and histopathology examination was done to calculate apoptotic factor expression such as AIF and caspase-3. Result Chronic compression on spinal cord causing myelopathy clinically on animal study, resulted in weakness of all extremities. Based on this study, the expression of AIF and caspase-3 is increasing in compression group in day 14 to day 21. Conclusion Chronic compression in spinal cord causing increase in AIF and caspase-3 in day 14 and day 21, and this may be caused by increasing of apoptotic expression on animal study.
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Affiliation(s)
- Sabri Ibrahim
- Department of Neurosurgery, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Abdurrahman Mousa
- Department of Neurosurgery, Faculty of Medicine, University of Sumatera Utara, Medan, Indonesia
| | - Wibi Riawan
- Department of Biochemistry and Pathology, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
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Rodríguez Domínguez V, Gandía González ML, García Feijoo P, Sáez Alegre M, Vivancos Sánchez C, Pérez López C, Isla Guerrero A. Tratamiento de la mielopatía cervical mediante abordaje posterior: laminoplastia vs. laminectomía con fijación posterior. ¿Existen diferencias desde el punto de vista clínico y radiológico? Neurocirugia (Astur) 2021. [DOI: 10.1016/j.neucir.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen Z, Cen S, Wu J, Guo R, Liu Z, Gao L. Use of zero-profile device for contiguous three-level anterior cervical discectomy and fusion: comparison with cage and plate construct. J Neurosurg Spine 2021; 35:219-226. [PMID: 34087791 DOI: 10.3171/2020.11.spine201319] [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: 07/16/2020] [Accepted: 11/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to compare a traditional cervical cage with a zero-profile (ZP) fixation device in patients who underwent three-level anterior cervical decompression and fusion (ACDF) in terms of patient-reported outcomes (visual analog scale [VAS], Japanese Orthopaedic Association [JOA], and Neck Disability Index [NDI] scores), radiographic findings (sagittal alignment 2 years after surgery and likelihood of fusion), and complications. METHODS This study was a retrospective case series. Between January 2012 and December 2016, 58 patients with cervical spondylotic myelopathy (CSM) who required three-level ACDF procedures, as identified by spinal surgeons, were treated with three-level ACDF and an anterior cage-plate construct (ACPC) (n = 38) or a three-level stand-alone ZP device (n = 20). On the basis of patient choice, patients were divided into two groups (ACPC group and ZP group). All patients completed a minimum of 2 years of follow-up. Patient-reported outcome scores included VAS, JOA, and NDI scores. The radiographic findings included sagittal alignment and likelihood of fusion 2 years after surgery. Data related to patient-reported outcomes and sagittal alignment were collected preoperatively, postoperatively, and at the final follow-up. Intraoperative and postoperative complications were also documented and analyzed. RESULTS The clinical outcomes, including VAS, JOA, and NDI scores, showed improvement in both groups, and no significant difference was observed between the two groups. Sagittal alignment and height of the fused segments were restored in all patients. However, the authors found no differences between the ZP and ACPC groups, and the groups exhibited similar fusion rates. The authors found no differences in complications, including dysphagia, adjacent-segment degeneration, and postoperative hematoma, between the groups. CONCLUSIONS Use of ZP implants yielded satisfactory long-term clinical and radiological outcomes that were similar to those of the standard ACPC. Additionally, the rates of complications between the groups were not significantly different. Although the best surgical option for multilevel CSM remains controversial, the results of this work suggest that ACDF with the ZP device is feasible, safe, and effective, even for multilevel CSM.
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Affiliation(s)
- Zhipeng Chen
- 1Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
| | - Shuizhong Cen
- 1Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
| | - Jionglin Wu
- 1Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
| | - Rui Guo
- 1Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
| | - Zhenhua Liu
- 2Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Liangbin Gao
- 1Department of Orthopedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou; and
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Higher incidence of cervical spinal cord compression in amyotrophic lateral sclerosis: a single-institute cohort study. Neurol Sci 2021; 43:1079-1086. [PMID: 34287724 DOI: 10.1007/s10072-021-05465-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although the relationship between amyotrophic lateral sclerosis (ALS) and cervical spondylotic myelopathy (CSM) is important, data relating to CSM complications in ALS remain lacking. PURPOSE We aimed to investigate and validate the spinal cord conditions of ALS patients. MATERIALS AND METHODS We recruited all patients diagnosed with ALS, Parkinson's disease (PD), or chronic inflammatory demyelinating polyneuropathy (CIDP) who were admitted to our department from April 1, 2017, to March 31, 2020. We analyzed the cervical or thoracolumbar magnetic resonance imaging (MRI) scans of these 128 patients. Data relating to spondylosis, cord compression, spinal canal diameter, spinal cord diameter, and the closest distance between the cervical spinal canal and cord were validated using MRI. RESULTS Of the 128 patients, 52 had ALS, 48 had PD, and 28 had CIDP. The proportions of both cervical spondylosis and cervical cord compression were highest in the ALS group compared with the other patient groups (p < 0.05). The proportion of cervical spondylosis in ALS patients reached 38.3%, and that of cervical cord compression reached 53.2%. The closest distance between the cervical spinal canal and cord was also significantly smaller in ALS patients compared with CIDP patients (p < 0.05). In contrast to the cervical cord findings, there were no significant differences in the thoracolumbar cord between ALS patients and the other patient groups. CONCLUSIONS Of the three disease groups, the proportion of CSM was highest in ALS patients. Furthermore, cervical cord conditions were significantly more crowded in the ALS patients than in the other patient groups.
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Miyakoshi N, Suda K, Kudo D, Sakai H, Nakagawa Y, Mikami Y, Suzuki S, Tokioka T, Tokuhiro A, Takei H, Katoh S, Shimada Y. A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018. Spinal Cord 2021; 59:626-634. [PMID: 32782342 DOI: 10.1038/s41393-020-00533-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 01/31/2023]
Abstract
STUDY DESIGN Retrospective epidemiological study. OBJECTIVES Since the causes and incidences of traumatic spinal cord injury (TSCI) in each country change over time, up-to-date epidemiological studies are required for countermeasures against TSCI. However, no nationwide survey in Japan has been conducted for about 30 years. The purpose of this study was therefore to investigate the recent incidence and characteristics of TSCI in Japan. SETTING Japan METHODS: Survey sheets were sent to all hospitals (emergency and acute care hospitals) that treated TSCI persons in Japan in 2018 and case notes were retrospectively reviewed. Frankel grade E cases were excluded from analysis. RESULTS The response rate was 74.4% (2804 of 3771 hospitals). The estimated annual incidence of TSCI excluding Frankel E was 49 per million, with a median age of 70.0 years and individuals in their 70s as the largest age group. Male-to-female ratio was 3:1. Cervical cord injuries occurred in 88.1%. Frankel D was the most frequent grade (46.3%), followed by Frankel C (33.0%). The most frequent cause was fall on level surface (38.6%), followed by traffic accident (20.1%). The proportion of fall on level surface increased with age. TSCI due to sports was the most frequent cause in teenagers (43.2%). CONCLUSIONS This nationwide survey in Japan showed that estimated incidence of TSCI, rate of cervical cord injury, and incomplete injury by falls appear to be increasing with the aging of the population.
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Affiliation(s)
- Naohisa Miyakoshi
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan. .,Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan.
| | - Kota Suda
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Japan
| | - Daisuke Kudo
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroaki Sakai
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopaedic Surgery, Spinal Injuries Center, Japan Organization of Occupational Health and Safety, Iizuka, Japan
| | - Yukihiro Nakagawa
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopaedic Surgery, Wakayama Medical University Kihoku Hospital, Katsuragi-cho, Japan
| | - Yasuo Mikami
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Rehabilitation Medicine, Graduate school of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinsuke Suzuki
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Neurosurgery, National Hospital Organization, Sendai Medical Center, Sendai, Japan
| | - Takamitsu Tokioka
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopedic Surgery, Kochi Health Sciences Center, Kochi, Japan
| | - Akihiro Tokuhiro
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Rehabilitation Medicine, Kibikogen Rehabilitation Center for Employment Injuries, Kibichuo, Japan
| | - Hiroshi Takei
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopedic Surgery, Miyuki Social Medical Corporation, Miyukikai Hospital, Kaminoyama, Japan
| | - Shinsuke Katoh
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Rehabilitation Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yoichi Shimada
- Prevention Committee of the Japan Medical Society of Spinal Cord Lesion, Fujisawa, Japan.,Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Gill M, Maheshwari V, Yadav AK, Gadhavi R. A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1726607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction To critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach.
Materials and Methods A retrospective study was conducted in a tertiary-level Armed Forces Hospital from June 2015 to December 2019. Preoperative assessment included a thorough clinical examination and functional and radiological assessment. The surgical decompression was done by an anterior or a posterior approach with instrumented fusion. Anterior approach was taken for single or two-level involvement and posterior approach for three or more cervical levels. The pre and postoperative neurological outcome was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) score along with measurement of canal diameter and cross-sectional area.
Results A total of 120 patients of CSM who underwent surgical decompression were analyzed. Both the groups were comparable and had male predominance. A total of 59 patients underwent surgical decompression by an anterior approach and the remaining 61 patients by the posterior approach. Out of the 59 patients operated by the anterior approach, 30 (50.85%) underwent anterior cervical discectomy and fusion (ACDF); remaining 29 (49.15%) underwent anterior cervical corpectomy and fusion (ACCF). In the posterior group (n = 61), 26 (42.6%) patients underwent laminoplasty and the remaining 35 (57.4%) underwent laminectomy with or without instrument fusion. Sixteen patients out of these underwent lateral mass fixation and the remaining 19 underwent laminectomy. There was functional improvement (mJOA and Nurick grade) and radiological improvement in both subgroups, which were statistically significant (p < 0.0001).
Conclusion A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.
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Affiliation(s)
- Maneet Gill
- Department of Neurosurgery, Army Hospital (R&R), New Delhi, India
| | | | | | - Rushikesh Gadhavi
- Department of Neurosurgery, Armed Forces Medical College, Pune, India
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Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis. BMC Musculoskelet Disord 2021; 22:340. [PMID: 33836709 PMCID: PMC8035773 DOI: 10.1186/s12891-021-04218-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/03/2021] [Indexed: 01/05/2023] Open
Abstract
Background The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5/C6 ACDF. Methods We constructed 10 preoperative finite element models of intact C4–C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10 mm), medium PDD (5 mm) and short PDD (0 mm). The changes in C4/C5 and C6/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed. Results The von Mises stress of C4/C5 and C6/C7 intervertebral discs had no significant differences (P > 0.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending. Conclusions The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.
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