1
|
Firempong GK, Sheppard WL, Gelfand Y, Ellingson BM, Holly LT. Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy. Clin Spine Surg 2023; 36:438-443. [PMID: 38031316 PMCID: PMC10691530 DOI: 10.1097/bsd.0000000000001479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 05/17/2023] [Indexed: 12/01/2023]
Abstract
STUDY DESIGN Prospective single institutional cohort study on degenerative cervical myelopathy (DCM) from 2009 to 2022. OBJECTIVE This study aims to assess the relationship among preoperative spinal cord signal change, postoperative signal change evolution, and functional outcome in patients undergoing surgery for DCM. SUMMARY OF BACKGROUND DATA There is conflicting evidence on whether spinal cord signal intensity influences functional outcomes in patients with DCM. PATIENTS AND METHODS This prospective study investigated 104 patients with DCM that underwent both preoperative and routine postoperative cervical spine magnetic resonance imaging (MRI) as part of a research protocol. Signal intensity/grade, modified Japanese Orthopedic Association (mJOA) scores, signal resolution, and patient demographics were assessed. RESULTS Sixty-eight of the subjects were found to have abnormal T2 spinal cord signal intensity changes on their preoperative MRI. The total mean preoperative mJOA score was 13.6, increasing postoperatively to 16 (P < 0.001). The presence or absence of preoperative spinal cord signal change was not associated with the change in mJOA score or neurological recovery rate after surgery. Of the 68 patients with preoperative T2 signal change, 36 were found to have an improvement in the T2-weighted signal grade after surgery and 32 had no change in postoperative signal grade. The mean improvement in mJOA score (3.7) and neurological recovery rate (70.3%) was significantly higher in the patients with preoperative signal change whose postoperative MRI signal change grade improved by at least one point compared with those that did not (2.0, 50.5%), (P < 0.001, P < 0.003). CONCLUSIONS The presence of preoperative T2-weighted signal change was associated with lower preoperative mJOA scores, but no change in mJOA after surgery or postoperative neurological recovery rate. However, improvement in T2-weighted spinal cord signal grade on postoperative MRI was significantly associated with a degree of neurological improvement after surgery.
Collapse
Affiliation(s)
- Gaylinn Kwame Firempong
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - William L Sheppard
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Yaroslav Gelfand
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Benjamin M. Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Neuroscience Interdisciplinary Graduate Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Langston T Holly
- Department of Orthopaedics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
2
|
Rajan PV, Pelle DW, Savage JW. New Imaging Modalities for Degenerative Cervical Myelopathy. Clin Spine Surg 2022; 35:422-430. [PMID: 36447347 DOI: 10.1097/bsd.0000000000001408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/30/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION Degenerative cervical myelopathy (DCM) is defined as dysfunction of the spinal cord as a result of compression from degenerative changes to surrounding joints, intervertebral disks, or ligaments. Symptoms can include upper extremity numbness and diminished dexterity, difficulty with fine manipulation of objects, gait imbalance, and incoordination, and compromised bowel and bladder function. Accurate diagnosis and evaluation of the degree of impairment due to degenerative cervical myelopathy remain a challenging clinical endeavor requiring a thorough and accurate history, physical examination, and assessment of imaging findings. METHODS A narrative review is presented summarizing the current landscape of imaging modalities utilized in DCM diagnostics and the future direction of research for spinal cord imaging. RESULTS AND DISCUSSION Current imaging modalities, particularly magnetic resonance imaging and, to a lesser extent, radiographs/CT, offer important information to aid in decision making but are not ideal as stand-alone tools. Newer imaging modalities currently being studied in the literature include diffusion tensor imaging, MR spectroscopy, functional magnetic resonance imaging, perfusion imaging, and positron emission tomography. These newer imaging modalities attempt to more accurately evaluate the physical structure, intrinsic connectivity, biochemical and metabolic function, and perfusion of the spinal cord in DCM. Although there are still substantial limitations to implementation, future clinical practice will likely be revolutionized by these new imaging modalities to diagnose, localize, surgically plan and manage, and follow patients with DCM.
Collapse
|
3
|
Akbari KK, Badikillaya V, Venkatesan M, Hegde SK. Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study. Global Spine J 2022; 12:366-372. [PMID: 32959684 PMCID: PMC9121159 DOI: 10.1177/2192568220951779] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). METHODS Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a "positive changes." Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. RESULTS Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant (P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively (r = 0.47; P = .01). CONCLUSION Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.
Collapse
Affiliation(s)
- Keyur Kantilal Akbari
- Apollo Hospital, Chennai, India,Keyur Kantilal Akbari, OPD No. 104, Counter Number 9, Apollo Hospitals, Greams Lane, Chennai 600006, India.
| | | | | | | |
Collapse
|
4
|
Martin AR, Tetreault L, Nouri A, Curt A, Freund P, Rahimi-Movaghar V, Wilson JR, Fehlings MG, Kwon BK, Harrop JS, Davies BM, Kotter MRN, Guest JD, Aarabi B, Kurpad SN. Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 9]. Global Spine J 2022; 12:130S-146S. [PMID: 34797993 PMCID: PMC8859711 DOI: 10.1177/21925682211057484] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. METHODS A narrative review was conducted to summarize the existing literature and highlight future directions. RESULTS Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. CONCLUSION Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.
Collapse
Affiliation(s)
- Allan R. Martin
- Department of Neurological Surgery, University of California Davis, Davis, CA, USA
| | - Lindsay Tetreault
- Department of Neurology, New York University, Langone Health, Graduate Medical Education, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland, Baltimore, MD, USA
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| |
Collapse
|
5
|
Shakya A, Sharma A, Singh V, Jaiswal A, Marathe N, Garje V. Preoperative T1 magnetic resonance imaging changes carry a poor postoperative prognosis in cervical myelopathy: A retrospective study of 182 patients. Surg Neurol Int 2021; 12:629. [PMID: 35350821 PMCID: PMC8942198 DOI: 10.25259/sni_1151_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
T2 scans are widely used to determine the prognosis for patients undergoing surgery for cervical myelopathy. In this study, we determined whether T1 MR changes in addition to T2 MR changes could have prognostic importance.
Methods:
This retrospective analysis involved 182 patients undergoing surgery for cervical myelopathy (2017–2020). There were 110 patients in Group 1 (only T2 MR changes) and 72 in Group 2 (both T1 and T2 MR changes). In addition, demographic, visual analog score (VAS), modified Japanese Orthopaedic Association (mJOA) scores, and operative details were recorded at 1 month, 3 months, 6 months, and 1 year postoperatively.
Results:
Notably, VAS scores were comparable at each point in time and were significantly better than the preoperative scores at 1 year postoperatively. Although mJOA scores were comparable at 1 month in both groups, they were better thereafter for Group 1 patients.
Conclusion:
The presence of T1 changes on the preoperative magnetic resonance imaging represented a poor prognostic indicator for the postoperative outcome compared to the presence of T2 changes alone.
Collapse
Affiliation(s)
- Akash Shakya
- Department of Orthopaedics and Spine Surgery, Dr. B.A.M. Hospital, Mumbai, Maharashtra, India
| | - Ayush Sharma
- Department of Orthopaedics and Spine Surgery, Dr. B.A.M. Hospital, Mumbai, Maharashtra, India
| | - Vijay Singh
- Department of Orthopaedics and Spine Surgery, Dr. B.A.M. Hospital, Mumbai, Maharashtra, India
| | - Ajay Jaiswal
- Department of Orthopaedics and Spine Surgery, Dr. B.A.M. Hospital, Mumbai, Maharashtra, India
| | - Nandan Marathe
- Spine Services, KEM Hospital, Mumbai, Maharashtra, India
| | - Vinayak Garje
- Department of Orthopaedics, ESIC Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
6
|
Abstract
STUDY DESIGN A bibliometric review of the literature. OBJECTIVES The aim of this study was to identify the most highly cited articles relating to cervical myelopathy and to analyze the most influential articles. SUMMARY OF BACKGROUND DATA Over the past several decades, a lot of research has been conducted regarding the subject of cervical myelopathy. Although there are a large number of articles on this topic, to our knowledge, this is the first bibliometric analysis. METHODS A selection of search terms and keywords were inputted into the "Dimensions" database and the most highly cited articles in cervical myelopathy were selected from high impact factor journals. The top 100 articles were analyzed for year of publication, authorship, publishing journals, institution and country of origin, subject matter, article type, and level of evidence. RESULTS The 100 most cited articles in the topic of cervical myelopathy were published from 1956 to 2015. These articles, their corresponding authors, and number of citations are shown in Table 1. The number of citations ranged from 121 times for the 100th article to 541 times for the top article in a total of 20 journals. The most common topic was operative technique, whereas the journals which contributed the most articles were the Spine journal and the Journal of Neurosurgery. CONCLUSION Our study provided an extensive list of the most historically significant articles regarding cervical myelopathy, acknowledging the key contributions made to the advancement of this field.Level of Evidence: 5.
Collapse
|
7
|
Abstract
STUDY DESIGN Retrospective study (data analysis). OBJECTIVE The purpose of this study was to assess the role of different factors on postoperative outcome of patients with degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA Ongoing degenerative changes of DCM lead to progressive neurological deficits. The optimal timing of surgical treatment is still unclear, especially in patients with mild DCM. METHODS Patients with DCM treated in our clinic between 2007 and 2016 were retrospectively analyzed. Pre- and postoperative neurological function was assessed by the modified Japanese Orthopaedic Association Score (mJOA Score) at different stages. The minimum clinically important difference (MCID) was used to evaluate the improvement after surgery. The comorbidities were recorded using the Charlson Comorbidity Index (CCI). Possible associations between age, sex, CCI, preoperative symptoms duration, high signal intensity (SI) on T2-weighted magnetic resonance imaging (MRI) with mJOA Score and MCID were analyzed using univariate analysis and multivariate regression models. Additionally, subgroup analysis was performed according to the severity of DCM (mild: mJOA Score ≥15 points; moderate: mJOA Score of 12-14 points; and severe: mJOA Score <12 points). RESULTS The mean age of the final cohort (n = 411) was 62.6 years (range: 31-96 years), 36.0% were females. High SI on T2-weighted MRI was detected in 60.3% of the cases. In the multivariate analysis, patients' age (P = 0.005), higher CCI (P = 0.001), and presence of high SI on T2-weighted MRI (P = 0.0005) were associated independently with lower pre- and postoperative mJOA Score and postoperative MCID. Subgroup analysis revealed age and high SI on T2-weighted MRI as predictors of pre- and postoperative mJOA. However, symptom duration did not influence neurological outcome according to the severity of DCM. CONCLUSION Surgery for DCM leads to significant functional improvement. However, better outcome was observed in younger individuals with lower CCI and absence of radiographic myelopathy signs. Therefore, DCM surgery, particularly before occurrence of high SI on MRI, seems to be essential for postoperative functional improvement regardless the above-mentioned confounders.Level of Evidence: 3.
Collapse
|
8
|
Ren H, Feng T, Wang L, Liu J, Zhang P, Yao G, Shen Y. Using a Combined Classification of Increased Signal Intensity on Magnetic Resonance Imaging (MRI) to Predict Surgical Outcome in Cervical Spondylotic Myelopathy. Med Sci Monit 2021; 27:e929417. [PMID: 33517342 PMCID: PMC7860148 DOI: 10.12659/msm.929417] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to verify whether the combined classification of increased signal intensity (ISI) on magnetic resonance imaging is more closely related to surgical outcomes than signal quality changes or signal longitudinal extent changes alone and to evaluate whether the combined classification ISI method could be used to predict surgical outcomes in cervical spondylotic myelopathy. MATERIAL AND METHODS Eighty-four patients (61 men and 23 women) who underwent surgery for cervical spondylotic myelopathy were included in this retrospective study. The patterns of ISI were classified into 3 categories based on (1) the quality of ISI into Grade 0: none, Grade 1: faint (fuzzy), and Grade 2: intense (sharp); (2) the longitudinal extent of ISI into none, focal, and multisegmental; and (3) the combined classification of the quality and longitudinal extent into Type 1 (none/none), Type 2 (focal/faint), Type 3 (focal/intense), Type 4 (multisegmental/faint), and Type 5 (multisegmental/intense). The multifactorial effects of variables were studied. A stepwise regression analysis was performed to verify whether this combined classification could predict outcome. RESULTS Of the 3 categories, the combined classification type of ISI was most closely related to recovery rate. Stepwise regression analysis confirmed the significance of combined classification of ISI as a predictor for surgical outcome. CONCLUSIONS A combined classification of ISI is more closely related to surgical outcomes than either signal quality changes or signal longitudinal extent changes alone and it could be used as a meaningful indicator for predicting surgical outcomes. We recommend further studies to confirm this finding.
Collapse
Affiliation(s)
- Hu Ren
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Tao Feng
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Linfeng Wang
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Junchuan Liu
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Peng Zhang
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Guangqing Yao
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| | - Yong Shen
- Department of Spine, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (mainland)
| |
Collapse
|
9
|
Nori S, Nagoshi N, Kono H, Kobayashi Y, Isogai N, Ninomiya K, Tsuji T, Horiuchi Y, Takemura R, Kimura R, Tsuji O, Suzuki S, Okada E, Yagi M, Nakamura M, Matsumoto M, Watanabe K, Ishii K, Yamane J. Baseline severity of myelopathy predicts neurological outcomes after posterior decompression surgery for cervical spondylotic myelopathy: a retrospective study. Spinal Cord 2021; 59:547-553. [PMID: 33495583 DOI: 10.1038/s41393-020-00603-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective multicenter study. OBJECTIVES To identify the usefulness of the baseline severity of myelopathy for predicting surgical outcomes for cervical spondylotic myelopathy (CSM). SETTING Seventeen institutions in Japan. METHODS This study included 675 persons with CSM who underwent posterior decompression. According to baseline severity, the individuals were divided into the mild (Japanese Orthopaedic Association [JOA] score ≥ 14.5), moderate (JOA score = 10.5-14), and severe (JOA score ≤ 10) groups. Surgical outcomes and clinical variables were compared between the groups. Logistic regression analysis was used to develop a prediction model for unsatisfactory symptom state (postoperative JOA score ≤ 14, residual moderate or severe myelopathy). RESULTS The mean (±standard deviation) age was 67 ± 12 years. The participants in the severe group were older than those in the mild group. Postoperative JOA scores were higher in the mild group than in the severe group. According to multivariate logistic regression analysis, the prediction model included preoperative JOA scores (odds ratio [OR] 0.60; 95% confidence interval [CI] 0.55-0.67) and age (OR 1.06, 95% CI 1.04-1.08). On the basis of the model, a representative combination of the thresholds to maximize the value of "sensitivity - (1 - specificity)" demonstrated a preoperative JOA score of 11.5 as a predictor of postoperative unsatisfactory symptom state in people around the mean age of the study cohort (67 years). CONCLUSIONS The combination of the baseline severity of myelopathy and age can predict postoperative symptom states after posterior decompression surgery for CSM.
Collapse
Affiliation(s)
- Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan. .,Keio Spine Research Group (KSRG), Tokyo, Japan.
| | - Hitoshi Kono
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Keiyu Orthopaedic Hospital, Gunma, Japan
| | - Yoshiomi Kobayashi
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Norihiro Isogai
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan
| | - Ken Ninomiya
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Department of Orthopaedic Surgery, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Takashi Tsuji
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Department of Orthopaedic Surgery, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Yosuke Horiuchi
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Department of Orthopaedic Surgery, Japan Community Health Care Organization Saitama Medical Center, Saitama, Japan
| | - Ryo Takemura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Ryusei Kimura
- Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Keio Spine Research Group (KSRG), Tokyo, Japan
| | - Ken Ishii
- Keio Spine Research Group (KSRG), Tokyo, Japan.,Spine and Spinal Cord Center, International University of Health and Welfare (IUHW) Mita Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Chiba, Japan
| | - Junichi Yamane
- Keio Spine Research Group (KSRG), Tokyo, Japan. .,Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Tokyo, Japan.
| |
Collapse
|
10
|
Wang S, Ren Z, Liu J, Zhang J, Tian Y. The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients. BMC Neurol 2020; 20:221. [PMID: 32473653 PMCID: PMC7261380 DOI: 10.1186/s12883-020-01799-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery. Methods A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery. Results The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series. Conclusions The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.
Collapse
Affiliation(s)
- Shujie Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China
| | - Zhifu Ren
- Department of Spine Surgery, Municipal Traditional Chinese Hospital, Weifang, Shandong, 261041, PR China
| | - Jia Liu
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China
| | - Ye Tian
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 1 Shuai Fu Yuan, Beijing, 100730, PR China.
| |
Collapse
|
11
|
Yu D, Kim SW, Jeon I. Clinical and Radiologic Features of Degenerative Cervical Myelopathy Depending on the Presence of Cord Signal Change. World Neurosurg 2020; 141:e97-e104. [PMID: 32389873 DOI: 10.1016/j.wneu.2020.04.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cord signal change (CSC) on magnetic resonance (MR) imaging is an important radiologic feature of degenerative cervical myelopathy (DCM). Occasionally, DCMs correlate with clinical symptoms with no CSC. The aim of this study was to evaluate clinical and radiologic features, depending on the presence of CSC in DCM. METHODS This retrospective study included 73 patients who underwent cervical laminoplasty for DCM. They were divided into 2 groups based on the presence of CSC on static MR imaging (positive CSC in group A and negative CSC in group B). Preoperative radiologic parameters on lateral radiographs and the severity of canal stenosis on MR imaging were analyzed. The functional outcomes were evaluated using the modified Japanese Orthopedic Association score and Nurick grade. RESULTS Group A showed more deteriorated canal stenosis (P < 0.001) and kyphotic change than did group B. C2-7 sagittal vertical axis (P = 0.003) of group A and C2-7 range of motion (C27ROM; P < 0.001) of group B were greater than in the opposite groups, respectively. In a multivariate analysis, greater width of the cervical canal (P = 0.002) and increased C27ROM (P = 0.002) were statistically significant radiologic parameters related to negative CSC. Group B showed better functional outcomes until 6 months postoperatively, with statistical significance. CONCLUSIONS DCM with negative CSC can be caused by a well-preserved cervical ROM, even with less deteriorated canal stenosis and kyphosis. C27ROM may be a helpful radiologic parameter in diagnosing DCM before CSC appears.
Collapse
Affiliation(s)
- Dongwoo Yu
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea
| | - Ikchan Jeon
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea.
| |
Collapse
|
12
|
Sawada M, Nakae T, Munemitsu T, Hojo M. Functional Connectivity Analysis and Prediction of Pain Relief in Association with Spinal Decompression Surgery. World Neurosurg 2020; 139:e316-e324. [PMID: 32298822 DOI: 10.1016/j.wneu.2020.03.200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although spinal decompression surgery is an effective treatment for myelopathy-induced upper limb pain, some postoperative patients suffer from residual pain in spite of adequate decompression. However, the neural mechanism underlying the poor outcome of pain relief is still unclear. The goal of this study was to explore the brain mechanisms involved in the poor recovery of upper limb pain after the spinal decompression surgery by using functional connectivity (FC) analysis. METHODS In this cross-sectional study, 17 patients who underwent cervical spinal decompression surgery were included. Functional MRI (fMRI) during a tactile stimulus for each hand was performed at 1 day before and 7 days after the surgery. In total, 34 fMRI scans (17 left and right upper limbs, respectively) were obtained before and after the surgery, respectively. The patients were divided into poor-recovery and good-recovery groups, and then we searched for the FC that was related to poor-recovery. RESULTS The poor-recovery group (n = 15) showed significantly stronger connectivity between the postcentral gyrus (postCG) and dorsolateral prefrontal cortex (DLPFC) than the good-recovery group (n = 12) preoperatively. When the cutoff value of the preoperative FC between the left postCG and right middle frontal gyrus included in DLPFC was >0.17, the sensitivity and specificity for poor recovery were 73% and 75%, respectively. CONCLUSIONS Our study showed that FC between the postCG and DLPFC may be a predictor of pain relief. This result suggested that assessing FC can lead to more informed surgical interventions for cervical spondylotic myelopathy.
Collapse
Affiliation(s)
- Masahiro Sawada
- Department of Neurosurgery, Shiga General Hospital, Moriyama, Japan.
| | - Takuro Nakae
- Department of Neurosurgery, Shiga General Hospital, Moriyama, Japan
| | | | - Masato Hojo
- Department of Neurosurgery, Shiga General Hospital, Moriyama, Japan
| |
Collapse
|
13
|
Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol 2020; 16:108-124. [PMID: 31974455 DOI: 10.1038/s41582-019-0303-0] [Citation(s) in RCA: 207] [Impact Index Per Article: 51.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord dysfunction in adults worldwide. DCM encompasses various acquired (age-related) and congenital pathologies related to degeneration of the cervical spinal column, including hypertrophy and/or calcification of the ligaments, intervertebral discs and osseous tissues. These pathologies narrow the spinal canal, leading to chronic spinal cord compression and disability. Owing to the ageing population, rates of DCM are increasing. Expeditious diagnosis and treatment of DCM are needed to avoid permanent disability. Over the past 10 years, advances in basic science and in translational and clinical research have improved our understanding of the pathophysiology of DCM and helped delineate evidence-based practices for diagnosis and treatment. Surgical decompression is recommended for moderate and severe DCM; the best strategy for mild myelopathy remains unclear. Next-generation quantitative microstructural MRI and neurophysiological recordings promise to enable quantification of spinal cord tissue damage and help predict clinical outcomes. Here, we provide a comprehensive, evidence-based review of DCM, including its definition, epidemiology, pathophysiology, clinical presentation, diagnosis and differential diagnosis, and non-operative and operative management. With this Review, we aim to equip physicians across broad disciplines with the knowledge necessary to make a timely diagnosis of DCM, recognize the clinical features that influence management and identify when urgent surgical intervention is warranted.
Collapse
|
14
|
MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression. Eur Radiol 2019; 30:357-369. [DOI: 10.1007/s00330-019-06352-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/13/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
|
15
|
Xu Y, Chen F, Wang Y, Zhang J, Hu J. Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis. J Orthop Surg Res 2019; 14:224. [PMID: 31319870 PMCID: PMC6639962 DOI: 10.1186/s13018-019-1265-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 07/08/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) often indicates severe compression in patients with cervical myelopathy (CM). The optimal surgical approach for CM patients with ISI on T2-weighted MRI remains unclear. This meta-analysis aims to compare the clinical outcomes between anterior and posterior approaches for the treatment of these patients. METHODS MEDLINE, EMBASE, Web of Science, and Chinese National Knowledge Infrastructure (CNKI) were searched for relevant studies through January 2019. Statistical comparisons were made when appropriate. RESULTS A total of 9 studies (748 participants) out of 1066 citations were included in this study. All of the selected studies were high quality, as indicated by the Newcastle-Ottawa scale and the Cochrane Collaboration tool for assessing the risk of bias. Clinical outcomes were compared between anterior and posterior approaches in 4 studies (237 participants). The preoperative Japanese Orthopedic Association (JOA) score was similar between the two groups [P = 0.98, weighted mean difference (WMD) = 0.01 (- 0.58, 0.59)]. The postoperative JOA score [P < 0.05, WMD = 0.68 (0.06, 1.30)] and recovery rates [P < 0.01, WMD = 0.12 (0.06, 0.17)] were significantly higher in the anterior group than in the posterior group. CONCLUSION The anterior approach was associated with better postoperative neural function than the posterior approach in CM patients with ISI on T2-weighted MRI.
Collapse
Affiliation(s)
- Yuan Xu
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Feng Chen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Yipeng Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jianhua Hu
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
| |
Collapse
|
16
|
Shabani S, Kaushal M, Budde M, Schmit B, Wang MC, Kurpad S. Comparison between quantitative measurements of diffusion tensor imaging and T2 signal intensity in a large series of cervical spondylotic myelopathy patients for assessment of disease severity and prognostication of recovery. J Neurosurg Spine 2019; 31:473-479. [PMID: 31174184 DOI: 10.3171/2019.3.spine181328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 03/20/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction. Recently, it has been shown that diffusion tensor imaging (DTI) may be a better biomarker than T2-weighted signal intensity (T2SI) on MRI for CSM. However, there is very little literature on a comparison between the quantitative measurements of DTI and T2SI in the CSM patient population to determine disease severity and recovery. METHODS A prospective analysis of 46 patients with both preoperative DTI and T2-weighted MRI was undertaken. Normalized T2SI (NT2SI), regardless of the presence or absence of T2SI at the level of maximum compression (LMC), was determined by calculating the T2SI at the LMC/T2SI at the level of the foramen magnum. Regression analysis was performed to determine the relationship of fractional anisotropy (FA), a quantitative measure derived from DTI, and NT2SI individually as well their combination with baseline preoperative modified Japanese Orthopaedic Association (mJOA) score and ∆mJOA score at the 3-, 6-, 12-, and 24-month follow-ups. Goodness-of-fit analysis was done using residual diagnostics. In addition, mixed-effects regression analysis was used to evaluate the impact of FA and NT2SI individually. A p value < 0.05 was selected to indicate statistical significance. RESULTS Regression analysis showed a significant positive correlation between FA at the LMC and preoperative mJOA score (p = 0.041) but a significant negative correlation between FA at the LMC and the ΔmJOA score at the 12-month follow-up (p = 0.010). All other relationships between FA at the LMC and the baseline preoperative mJOA score or ∆mJOA score at the 3-, 6-, and 24-month follow-ups were not statistically significant. For NT2SI and the combination of FA and NT2SI, no significant relationships with preoperative mJOA score or ∆mJOA at 3, 6, and 24 months were seen on regression analysis. However, there was a significant correlation of combined FA and NT2SI with ∆mJOA score at the 12-month follow-up. Mixed-effects regression revealed that FA measured at the LMC was the only significant predictor of ΔmJOA score (p = 0.03), whereas NT2SI and time were not. Goodness-of-fit analysis did not show any evidence of lack of fit. CONCLUSIONS In this large prospective study of CSM patients, FA at LMC appears to be a better biomarker for determining long-term outcomes following surgery in CSM patients than NT2SI or the combination values at LMC.
Collapse
Affiliation(s)
- Saman Shabani
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Mayank Kaushal
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Matthew Budde
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Brian Schmit
- 2Department of Biomedical Engineering, Marquette University, Milwaukee, Wisconsin
| | - Marjorie C Wang
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| | - Shekar Kurpad
- 1Department of Neurosurgery, Medical College of Wisconsin; and
| |
Collapse
|
17
|
The relationship between preoperative factors and the presence of intramedullary increased signal intensity on T2-weighted magnetic resonance imaging in patients with cervical spondylotic myelopathy. Clin Neurol Neurosurg 2019; 178:1-6. [PMID: 30660852 DOI: 10.1016/j.clineuro.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/03/2019] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate preoperative factors affecting the presence of intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) in patients with cervical spondylotic myelopathy (CSM) and the impact of ISI on clinical manifestations. PATIENTS AND METHODS Eighty-nine patients with CSM were retrospectively reviewed from January 2013 to December 2016 in our hospital. Based on the presence or absence of ISI on axial and sagittal T2-weighted MRI, patients were divided into ISI group (48 cases) and non-ISI group (41 cases). Factors such as age, sex, body mass index (BMI), duration of symptoms, clinical symptoms and signs, number and distribution of spinal cord compression levels, preoperative Japanese Orthopedic Association (JOA) score, preoperative C2-C7 lordotic angle, preoperative C2-C7 range of motion (ROM), maximal canal compromise (MCC) and maximal spinal cord compression (MSCC) were initially compared using univariate analysis. Factors with significant result in univariate analysis were included in multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were applied to evaluate the reliability of multivariate logistic regression model. RESULTS Univariate analysis showed that the number of spinal cord compression levels, preoperative JOA score, MCC and MSCC might be related to the presence of ISI (P < 0.05). Furthermore, multivariate logistic regression analysis revealed that the number of spinal cord compression levels (OR = 0.203, P < 0.05), preoperative JOA score (OR = 4.274, P < 0.05) and MSCC (OR = 0.250, P < 0.05) were independent preoperative risk factors associated with the presence of ISI, yielding an AUC of 0.9558. Patients with ISI showed a trend of increasing clinical symptoms and signs, and also exhibited statistically significantly increased frequencies of clumsy hands, lower limb spasticity, impairment of gait, broad-based, unstable gait, weakness and motor deficits (P < 0.05). CONCLUSION Multilevel spinal cord compression, lower preoperative JOA score and greater MSCC are independent preoperative risk factors related to the presence of ISI on T2-weighted MRI in patients with CSM. Patients with ISI tend to have more clinical symptoms and signs, especially in lower limb manifestations and motor deficits.
Collapse
|
18
|
Hamdan ARK. The Relation between Cord Signal and Clinical Outcome after Anterior Cervical Discectomy in Patients with Degenerative Cervical Disc Herniation. Asian J Neurosurg 2019; 14:106-110. [PMID: 30937019 PMCID: PMC6417293 DOI: 10.4103/ajns.ajns_262_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Cervical spondylotic myelopathy is a cervical cord compressive lesion that occurs as a result of the normal degenerative process which may cause magnetic resonance imaging (MRI) cord intensity changes that may worsen the clinical outcome even after successful anterior cervical decompression. Objective To assess the relation between MRI T2 Weighted images (T2 WI) hyperintense cord signal and clinical outcome after anterior cervical discectomy in patients with degenerative cervical disc herniation. Materials and Methods This is a retrospective observational study that was conducted on twenty-five patients with degenerative cervical disc prolapse associated with MRI T2WI hyperintense cord signal, at the Department of Neurosurgery, Qena University Hospital, South Valley University from August 2014 to December 2016. A complete clinical and radiological evaluation of the patients was done. Anterior cervical discectomy and fusion was done for all patients. Patients were clinically assessed preoperatively and postoperatively at 3, 6, and 12 months using Modified Japanese Orthopedic Association (MJOA) score. Radiographic assessment was done by preoperative and postoperative T2WI MRI. The statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software (version 22.0). Results There were 25 patients included in the study; 16 (64%) females and 9 (36%) males. The mean age was 46.89 ± 7.52 standard deviation (SD) years with range from 26 to 64 years, 3 (12%) patients had worsened in the form of postoperative motor power deterioration, and 14 (56%) patients has no improvement and remain as preoperative condition. The remaining 8 (32%) patients had a reported postoperative improvement of symptoms and signs according to MJOA score. The mean follow-up period (in months) was 11 ± 2.34 (SD). Conclusion The presence of T2W hyperintense signal on preoperative MRI predicts a poor surgical outcome in patients with cervical disc prolapse. The regression of T2W ISI postoperatively correlates with better functional outcomes.
Collapse
|
19
|
Fortin M, Wilk N, Dobrescu O, Martel P, Santaguida C, Weber MH. Relationship between cervical muscle morphology evaluated by MRI, cervical muscle strength and functional outcomes in patients with degenerative cervical myelopathy. Musculoskelet Sci Pract 2018; 38:1-7. [PMID: 30059855 DOI: 10.1016/j.msksp.2018.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 06/11/2018] [Accepted: 07/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cervical muscle alterations have been reported in patients with chronic neck pain, but the assessment of muscle morphology and strength has been overlooked in patients with degenerative cervical myelopathy (DCM). OBJECTIVES This study aimed to investigate the relationship between cervical muscle degenerative changes observed on MRI, muscle strength and symptoms severity in patients diagnosed with DCM. DESIGN Observational study. METHODS Cervical muscle measurements of total cross-sectional area (CSA), functional CSA (fat free area, FCSA) and ratio of FCSA/CSA (e.g. fatty infiltration) were obtained from T2-weighted axial MR images from C2-C3 to C6-C7 in 20 patients. Muscle strength was assessed manually using a microFET2 dynamometer. The association between cervical muscle morphology parameters, muscle strength, symptoms severity and functional status was investigated. RESULTS Greater mean CSA and FCSA was associated with greater overall muscle strength. The mean FCSA explained 37%, 76%, 39%, 20% and 65% of the total variance in flexion, extension, right-side bending, left-side bending and overall muscle strength, respectively. The mean ratio of FCSA/CSA was not significantly associated with cervical muscle strength in any direction. However, greater FCSA/CSA ratio (e.g. less fatty infiltration) was associated with lower disability score (p = 0.02, R2 = 0.20). CONCLUSIONS Cervical muscle lean muscle mass was positively associated with cervical muscle strength in patients with DCM. Moreover, greater fatty infiltration in the cervical extensor muscles was associated with lower functional score. Such findings suggest that clinicians should pay greater attention to cervical muscle morphology and function in patients with DCM.
Collapse
Affiliation(s)
- Maryse Fortin
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada; PERFORM Centre, Concordia University, Montreal, Quebec, Canada.
| | - Nikola Wilk
- McGill University, Faculty of Medicine, Montreal, Quebec, Canada
| | | | - Philippe Martel
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
| | - Carlo Santaguida
- McGill University, Faculty of Medicine, Department of Neurology and Neurosurgery, Montreal, Quebec, Canada
| | - Michael H Weber
- McGill University Health Centre, Montreal General Hospital Site, Department of Orthopedic Surgery, Montreal, Quebec, Canada
| |
Collapse
|
20
|
Wee TC, O'Riordan J. Case report of C5 palsy after C3-C6 posterior decompression and instrumented fusion in a patient undergoing inpatient rehabilitation. Biomedicine (Taipei) 2018; 8:20. [PMID: 30141407 PMCID: PMC6108229 DOI: 10.1051/bmdcn/2018080320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 11/14/2022] Open
Abstract
We report on a patient who had neurological deterioration attributed to C5 palsy post C3-C6 posterior decompression and instrumented fusion. A 60-year old man was admitted after a fall from an electric scooter. MRI of the cervical spine confirmed severe cervical spondylosis causing cord compression at C4/5 with associated cord oedema. He underwent posterior cervical decompressive surgery, and he remained neurologically stable post operatively. However, he subsequently developed acute left upper limb weakness limited to the C5 myotome 1 week after surgery whilst undergoing inpatient rehabilitation. A repeat MRI of the cervical spine did not reveal any new changes that may explain his symptoms. He was started on intravenous dexamethasone. C5 palsy after cervical decompressive surgery is not uncommon. There is no specific evidence-based treatment and it carries a generally good prognosis. The aim of this case report is to highlight this complication and raise awareness amongst physicians.
Collapse
Affiliation(s)
- Tze Chao Wee
- Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | | |
Collapse
|
21
|
Wei L, Cao P, Xu C, Wu H, Hu B, Tian Y, Yuan W. Comparison of the Prognostic Value of Different Quantitative Measurements of Increased Signal Intensity on T2-Weighted MRI in Cervical Spondylotic Myelopathy. World Neurosurg 2018; 118:e505-e512. [PMID: 30257303 DOI: 10.1016/j.wneu.2018.06.224] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate whether different quantitative measurements of increased signal intensity (ISI) on T2-weighted magnetic resonance imaging are useful for predicting surgical outcome in patients with cervical spondylotic myelopathy (CSM). METHODS We retrospectively reviewed 108 patients with ISI who underwent surgery for CSM. Clinical outcome was evaluated via the Japanese Orthopaedic Association (JOA) score and the recovery rate. Patients were divided into 2 groups based on the JOA recovery rate: good (≥50%) and fair (<50%). The quantitative measurements of ISI included the maximum vertical length and the signal change ratio (SCR). C2-C7 sagittal alignment, C2-C7 sagittal vertical axis, C2-C7 range of motion, maximum spinal cord compression, and maximum canal compromise also were assessed. RESULTS There were no significant differences in cervical sagittal alignment parameters between the groups. Multivariate analysis showed that a longer duration of symptoms, a lower preoperative JOA score, a longer preoperative ISI length, and a greater preoperative SCR were negatively associated with clinical outcomes. Receiver operating characteristic curve analysis showed that the best cutoff values of ISI length and SCR as negative predictors of surgical outcome were 15.50 mm and 1.56, respectively, and the areas under the receiver operating characteristic curve of preoperative ISI length, SCR that discriminate recovery rate of JOA score (≥50%, <50%) were 0.8507, 0.8422, respectively, and was 0.8903 for a combination of the 2. CONCLUSIONS Duration of symptoms, preoperative JOA score, preoperative ISI length, and SCR can reflect surgical outcome in patients with CSM; however, cervical sagittal alignment may not affect surgical outcome. Combining ISI length and SCR to depict ISI on T2-weighted magnetic resonance imaging is optimal and accurate. Patients with ISI length >15.50 mm and SCR >1.56 have fair surgical recovery.
Collapse
Affiliation(s)
- Leixin Wei
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Peng Cao
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chen Xu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Huiqiao Wu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Hu
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ye Tian
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Wen Yuan
- Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| |
Collapse
|
22
|
Takeuchi K, Yokoyama T, Wada KI, Kudo H. Relationship between Enlargement of the Cross-Sectional Area of the Dural Sac and Neurological Improvements after Cervical Laminoplasty: Differences between Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament. Spine Surg Relat Res 2018; 3:27-36. [PMID: 31435548 PMCID: PMC6690118 DOI: 10.22603/ssrr.2018-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/28/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction The purpose of this study was to investigate the relationship between postoperative enlargement of the dural sac cross-sectional area at the symptomatic level and neurological improvements after laminoplasty. Methods The cross-sectional areas of the dural sac at the symptomatic level before and after laminoplasty and the expansion ratio (post-/preoperative cross-sectional area) were measured using magnetic resonance imaging in patients with ossification of the posterior longitudinal ligament (OPLL) (n = 25) and patients with cervical spondylotic myelopathy (CSM) (n = 49). The relationships between the expansion ratio and the Japanese Orthopedic Association (JOA) score, JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and postoperative laminae morphology were investigated. Results In the OPLL group, the expansion ratio was significantly positively correlated with the postoperative JOA score (P = 0.025), recovery rate of the JOA score (P = 0.026), and postoperative change in lower extremity sensory function according to the JOA score (P = 0.0375); furthermore, patients whose JOACMEQ responses indicated positive outcomes for lower extremity function had a significantly larger expansion ratio than patients with negative results (P = 0.027). In the CSM group, the expansion ratio showed no correlation with the JOA and JOACMEQ scores. The expansion ratio was significantly positively correlated with the width between bilateral gutters in both CSM (P = 0.025) and OPLL (P = 0.0451). In the OPLL group, the expansion ratio in those with a gutter position of less than 0.8 was significantly smaller than that those with a gutter position of more than 0.8 (P = 0.0156). However, there was no correlation between the gutter position and the recovery rate of the JOA score. Conclusions In OPLL, insufficient enlargement of the cross-sectional area of the dural sac at the symptomatic level leads to poor neurological improvements after laminoplasty.
Collapse
Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| |
Collapse
|
23
|
Postoperative Resolution of Magnetic Resonance Imaging Signal Intensity Changes and the Associated Impact on Outcomes in Degenerative Cervical Myelopathy: Analysis of a Global Cohort of Patients. Spine (Phila Pa 1976) 2018; 43:824-831. [PMID: 28953706 DOI: 10.1097/brs.0000000000002426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Subanalysis of the prospective AOSpine CSM North America and International studies. OBJECTIVE To describe the postoperative changes in magnetic resonance imaging (MRI) spinal cord signal intensity in degenerative cervical myelopathy (DCM) patients and to investigate the impact of its postoperative resolution on clinical outcomes. SUMMARY OF BACKGROUND DATA When examining the spinal cord, hyperintensity found in MRI T2-weighted images and hypointensity in T1-weighted images are known to correlate with preoperative severity of DCM and to predict postoperative neurological recovery. However, the clinical importance of these signal intensity changes in postoperative images has not been established. METHODS Among 757 surgical DCM patients enrolled in two prospective multicenter studies, postoperative MRI images obtained between 6 and 24 months after the operation were examined with a focus on T2 hyper- and T1 hypointensity in the spinal cord. The 2-year postoperative Nurick grade, modified Japanese Orthopaedic Association score and modified Japanese Orthopaedic Association recovery rate (RR) were analyzed between patients with or without resolution of signal intensity changes. RESULTS A total of 167 patients with preoperative T2 hyperintensity were included with complete postoperative MRI images. Of these patients, 11% showed resolution of signal intensity changes, 70% retained T2 hyperintensity only, and 19% showed both T2 hyper- and T1 hypointensity postoperatively. There was a stepwise trend toward worse postoperative outcomes, with the no signal intensity change group showing the best outcome and the T1 hypointensity group showing the worst (mean RR: 72% vs. 51% vs. 36%, P = 0.02). Patients who exhibited resolution of T2 hyperintensity showed better outcomes than those who retained it (RR: 72% vs. 47%, P = 0.04), but the resolution of T1 hypointensity was not associated with improved outcomes (RR: 38% vs. 26%, P = 0.36). CONCLUSION Postoperative resolution of T2 hyperintensity in patients with DCM was associated with the best clinical outcomes, whereas those with T1 hypointensity showed the worst. LEVEL OF EVIDENCE 3.
Collapse
|
24
|
Clinical and Radiologic Results of Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy in Elderly Patients with T2-Weighted Increased Signal Intensity. World Neurosurg 2018; 112:e520-e526. [DOI: 10.1016/j.wneu.2018.01.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/08/2018] [Accepted: 01/11/2018] [Indexed: 11/20/2022]
|
25
|
Chen G, Wang Y, Wang Z, Zhu R, Yang H, Luo Z. Analysis of C5 palsy in cervical myelopathy with massive anterior compression following laminoplasty. J Orthop Surg Res 2018; 13:26. [PMID: 29394951 PMCID: PMC5797409 DOI: 10.1186/s13018-018-0715-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little data is available about comparison of the incidence and clinical characteristics of the C5 palsy between patients of cervical myelopathy with occupying ratio greater than 50% and those with occupying ratio less than 50% following laminoplasty. METHODS One-hundred eighteen patients with cervical myelopathy who underwent open door laminoplasty were reviewed in this study. The patients were divided into two groups: group A comprising 55 patients with an anterior occupying ratio greater than 50% and group B comprising 63 patients with an anterior occupying less than 50%. Clinical and radiological outcomes were assessed between two groups. RESULTS No statistically difference was found in preoperative Japanese Orthopedic Association (JOA) score of both groups (10.7 ± 1.7 in group A vs 10.9 ± 1.1 in group B, P > 0.05). Improvements in postoperative JOA score were achieved, and there was a statistical difference (14.0 ± 1.4 in group A vs 14.8 ± 0.9 in group B, P < 0.05). Group A had a lower rate of recovery than group B (P < 0.05). Totally, 12 of 118 (10.2%) patients developed the C5 palsy postoperatively. C5 palsy occurred in 3 of 63 patients in the group B compared with 9 of 55 in the group A. Statistically significant difference was found in the incidence of C5 palsy between the two groups (P < 0.05). Furthermore, patients in group A required significantly longer recovery periods than group B. Both preoperative and postoperative MRI presented more levels of T2 high-signal lesion in group A than group B. The degree of posterior shift of the cord after posterior decompression in group A was less than group B (P < 0.05). CONCLUSIONS Patients with a high degree of anterior compression have higher risk of C5 palsy than those with a relative low degree of anterior compression.
Collapse
Affiliation(s)
- Guangdong Chen
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China
| | - Yifan Wang
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China
| | - Zhidong Wang
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China
| | - Ruofu Zhu
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China
| | - Huilin Yang
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China.
| | - Zongping Luo
- Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute of Soochow University, 188 Shizi St, Suzhou, Jiangsu Province, 215006, China.
| |
Collapse
|
26
|
Ryan K, Goncalves S, Bartha R, Duggal N. Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery. J Neurosurg Spine 2018; 28:379-388. [PMID: 29350595 DOI: 10.3171/2017.7.spine1768] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention. METHODS A 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery. RESULTS After surgical intervention, an increased percentage blood oxygen level-dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level-dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01). CONCLUSIONS Plasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.
Collapse
Affiliation(s)
- Kayla Ryan
- 1Department of Medical Biophysics and.,2Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario; and
| | - Sandy Goncalves
- 2Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario; and
| | - Robert Bartha
- 1Department of Medical Biophysics and.,2Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario; and
| | - Neil Duggal
- 3Department of Clinical Neurological Sciences, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| |
Collapse
|
27
|
Tetreault L, Palubiski LM, Kryshtalskyj M, Idler RK, Martin AR, Ganau M, Wilson JR, Kotter M, Fehlings MG. Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy. Neurosurg Clin N Am 2018; 29:115-127.e35. [DOI: 10.1016/j.nec.2017.09.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
28
|
Lin X, Li C, Lin Q, Zheng Z. Intraoperative neuromonitoring loss in abnormal magnetic resonance imaging signal intensity from patients with cervical compressive myelopathy. J Neurol Sci 2017; 381:235-239. [PMID: 28991689 DOI: 10.1016/j.jns.2017.08.3261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Our objective of this study was to evaluate if cervical compressive myelopathy (CCM) patients with preoperative abnormal magnetic resonance imaging (MRI) might easily lead to intraoperative neuromonitoring (IONM) loss. METHOD A consecutive series of 152 CCM patients who underwent cervical cord decompression were enrolled in this study between December 2013 and February 2017. All patients with abnormal MRI signal intensity were divided into 2 groups (group 1: T2-WIs hyperintensity; group 2: both T2-WIs hyperintensity and T1-WIs hypointensity). Relevant IONM changes were identified as significant transcranial motor evoked potentials (MEP) loss associated with surgical decompression of cervical cord. RESULTS There were 121 patients in group 1, and then 6 cases showed IONM degeneration; 31 patients in group 2, and then 13 cases showed IONM degeneration (6/121 versus 13/31, p=0.000). Moreover, one case presented transient new spinal deficits after surgery, no permanent spinal deficit in group 1; 5 cases presented transient new spinal deficits, 2 cases showed permanent spinal deficit in group 2. And in group 2 the MEP amplitude before and after decompression had significant difference (134μV±30.2 versus 65μV±26.2, *p<0.05). CONCLUSION Our results suggest that the IONM degenerations or postoperative spinal deficits are more likely to appear on patients with abnormal T2-WIs and T1-WIs. Appropriate and timely interventions are probably useful for IONM recovery.
Collapse
Affiliation(s)
- Xiangquan Lin
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Chaoxiong Li
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Qin Lin
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China
| | - Zhong Zheng
- Department of Orthopedics, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian 350007, PR China.
| |
Collapse
|
29
|
Surgical outcomes of laminoplasty for cervical spondylotic myelopathy in very elderly patients (older than 80 years): Time from symptom onset to surgery and changes in spinal cord signal intensity on MRI. Clin Neurol Neurosurg 2017; 160:78-82. [DOI: 10.1016/j.clineuro.2017.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 11/23/2022]
|
30
|
Waly FJ, Abduljabbar FH, Fortin M, Nooh A, Weber M. Preoperative Computed Tomography Myelography Parameters as Predictors of Outcome in Patients With Degenerative Cervical Myelopathy: Results of a Systematic Review. Global Spine J 2017; 7:521-528. [PMID: 28894681 PMCID: PMC5582716 DOI: 10.1177/2192568217701101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To determine the preoperative computed tomography (CT) myelogram imaging parameters in patients diagnosed with degenerative cervical myelopathy (DCM) that correlate with severity of DCM and predict postoperative patients' functional outcome. METHODS An electronic database search was performed using Ovid Medline and Embase. CT myelogram studies investigating the correlation between imaging characteristics and DCM severity or postoperative outcomes were included. Two independent reviewers performed citation screening, selection, qualitative assessment, and data extraction using an objective and blinded protocol. RESULTS A total of 5 studies (402 patients) were included in this review and investigated the role of preoperative CT myelogram parameters in predicting the functional outcome after surgical treatment of DCM. All studies were retrospective cohort studies. CT myelogram characteristics included the transverse area of the spinal cord at maximum level of compression, spinal canal narrowing, number of blocks, spinal canal diameter, and flattening ratio. There is low evidence suggesting that patients with a preoperative transverse area of the spinal cord >30 mm2 at the level of maximum compression have better postoperative recovery and outcome. We found no studies investigating the correlation between preoperative CT myelogram parameters and DCM severity. CONCLUSIONS Patients with greater transverse area of spinal cord at the level of maximum compression on the preoperative CT myelogram are more likely to have better neurological outcome after surgery. There is insufficient evidence to suggest that any of the other CT myelogram parameters investigated are predictors of postoperative outcomes in patients with DCM.
Collapse
Affiliation(s)
- Feras J. Waly
- McGill University Health Centre, Montreal, Quebec, Canada,University of Tabuk, Tabuk, Saudi Arabia,Feras J. Waly, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, T8-200, Montreal, Quebec, H3G 1A4, Canada.
| | - Fahad H. Abduljabbar
- McGill University Health Centre, Montreal, Quebec, Canada,King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maryse Fortin
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Anas Nooh
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Weber
- McGill University Health Centre, Montreal, Quebec, Canada
| |
Collapse
|
31
|
Prognostic Value of Preoperative Nurick Grade and Time with Symptoms in Patients with Cervical Myelopathy and Gait Impairment. World Neurosurg 2017; 105:314-320. [PMID: 28602883 DOI: 10.1016/j.wneu.2017.05.166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/28/2017] [Accepted: 05/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. METHODS A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. RESULTS A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A greater preoperative Nurick grade was associated with lower odds of gait improvement (odds ratio 0.74; 95% confidence interval 0.53-0.99, P = 0.048) and gait recovery (odds ratio 0.27; 95% confidence interval 0.17-0.43, P < 0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared with 36.4% for patients with symptoms for over 12 months (P < 0.001). Patients with symptoms for 12 months or less had a 59.6% gait recovery rate, compared to 24.2% in patients with symptoms for over 12 months (P < 0.001). Having symptoms for over 12 months was independently associated with lower odds of improvement and recovery. CONCLUSIONS Patients with a greater preoperative Nurick grade and symptoms for more than 12 months may have significantly lower odds of experiencing gait improvement or gait recovery after surgery for cervical myelopathy. This study's conclusion favors early intervention in patients with cervical myelopathy.
Collapse
|
32
|
Diffusion tensor imaging can predict surgical outcomes of patients with cervical compression myelopathy. 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 2017. [DOI: 10.1007/s00586-017-5191-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
33
|
Metabolic Imaging Using Proton Magnetic Spectroscopy as a Predictor of Outcome After Surgery for Cervical Spondylotic Myelopathy. Clin Spine Surg 2017; 30:E615-E619. [PMID: 28525487 PMCID: PMC4510035 DOI: 10.1097/bsd.0000000000000248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN A single-center magnetic resonance spectroscopy (MRS) imaging and surgical outcome study involving 16 patients with cervical spondylotic myelopathy (CSM). OBJECTIVE In the present study, we assess the utility of MRS to quantify metabolic changes within the spinal cord and predict surgical outcome in CSM patients. SUMMARY OF BACKGROUND DATA MRS is an advanced spinal imaging modality that can provide pertinent metabolic and biochemical information regarding spinal cord function. Previous studies have demonstrated significant abnormalities in specific cellular metabolite concentrations in CSM patients. METHODS Sixteen patients with CSM were evaluated. Single voxel MRS was performed in the cervical cord. N-acetyl-aspartate (NAA) and choline metabolite concentration ratios with respect to creatine were quantified, as well as the presence or absence of a lactate peak. The modified Japanese Orthopaedic Association (mJOA) scale was used as the functional assessment measure. Correlation of MRS metabolites with change in mJOA score was performed. RESULTS The mean follow-up time was 19 months. There was a statistically significant improvement between mean preoperative and postoperative mJOA score after surgery (P<0.0001). The NAA/Cr ratio demonstrated a significant relationship to the change in mJOA score after surgery (P=0.0479; R=0.2513). The Cho/NAA ratio demonstrated an even stronger correlation with the change in mJOA score after surgery (P=0.0065; R=0.4219). Neither the Cho/Cr ratio, nor the presence of a lactate peak or T2-weighted signal change was significantly correlated with change in mJOA score after surgery. CONCLUSIONS MRS is a novel, noninvasive imaging modality that provides pertinent information regarding spinal cord cellular and metabolic function. In a cohort of operatively treated CSM patients, the NAA/Cr and Cho/NAA ratios were predictive of neurological outcome, as both were significantly associated with change in mJOA score after surgery.
Collapse
|
34
|
Correlation between Preoperative Magnetic Resonance Imaging Signal Intensity Changes and Clinical Outcomes in Patients Surgically Treated for Cervical Myeloradiculopathy. Asian Spine J 2017; 11:174-180. [PMID: 28443160 PMCID: PMC5401830 DOI: 10.4184/asj.2017.11.2.174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 07/19/2016] [Accepted: 07/25/2016] [Indexed: 11/13/2022] Open
Abstract
Study Design This was a single surgeon, single center-based retrospective study with prospective data collection. Purpose To assess the correlation between T2-weighted magnetic resonance imaging (MRI) signal intensity (SI) changes and factors such as age, duration of symptoms, baseline modified Japanese Orthopedic Association (mJOA) score and to determine its prognostic value in predicting recovery after surgery. Overview of Literature Whether intramedullary cord T2-weighted MRI SI changes can predict operative outcomes of cervical myeloradiculopathy remains debatable, with only a few prospective studies analyzing the same. Methods Forty-six consecutive patients who underwent cervical myeloradiculopathy were included and were followed up for an average of 1 year. Preoperative T2-weighted MRI SI grading was performed for all patients. The correlation between MRI SI changes and age, duration of symptoms, preoperative mJOA score, and mJOA score at 1-year follow-up were analyzed. Results Fifteen patients had single-level (21.73%) or double-level (10.86%) prolapsed discs; 54.34% had degenerative cervical spondylosis with canal stenosis or multilevel disc prolapse and 13.07% had ossified posterior longitudinal ligaments. The mean age was 56.17±9.53 years (range, 35–81 years). The mean baseline mJOA score was 10.83±2.58 (range, 6–16), which postoperatively improved to 13.59±2.28 (range, 8–17; p<0.001). There was a statistically significant correlation between mJOA score at 1 year and MRI T2 SI grading (p=0.017). Conclusions Patients with longer symptom durations had high grades of intramedullary cord T2-weighted MRI SI changes. Age and preoperative neurological status were not significantly correlated with the existence of intramedullary cord SI changes. However, patients without or with mild and diffuse intramedullary cord T2-weighted MRI SI changes had better postoperative neurological recovery than those with sharp and focal SI changes.
Collapse
|
35
|
Nouri A, Martin AR, Mikulis D, Fehlings MG. Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques. Neurosurg Focus 2017; 40:E5. [PMID: 27246488 DOI: 10.3171/2016.3.focus1667] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.
Collapse
Affiliation(s)
- Aria Nouri
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Allan R Martin
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - David Mikulis
- Brain Imaging & Behaviour Systems, University of Toronto; and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael G Fehlings
- Divisions of 1 Neurosurgery and Spine Program and.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Wang K, Chen Z, Zhang F, Song Q, Hou C, Tang Y, Wang J, Chen S, Bian Y, Hao Q, Shen H. Evaluation of DTI Parameter Ratios and Diffusion Tensor Tractography Grading in the Diagnosis and Prognosis Prediction of Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2017; 42:E202-E210. [PMID: 28207659 DOI: 10.1097/brs.0000000000001784] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE To explore the correlations between diffusion tensor imaging (DTI) ratios and diffusion tensor tractography (DTT) grading with clinical symptoms and outcomes of cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA In addition to magnetic resonance imaging (MRI) and computed tomography, DTI may be useful in understanding pathophysiology of spinal cord in earlier stages of the CSM but it may be confounded by age and cervical level, and previous studies had small sample sizes. METHODS Controls (n = 36) and patients with CSM (n = 93) underwent magnetic resonance imaging (MRI) and DTI at the Changhai Hospital of Shanghai between September 2011 and March 2013. Apparent diffusion coefficient (ADC), fractional anisotropy (FA) of white matter (WM), and central grey matter (GM) were assessed. Patients were divided into three MRI grades: no abnormal signals; increased T2WI; and increased T2WI and low T1WI. DTT images were divided into three grades: no abnormal signals; abnormal local signal cord and disordered fiber tracts; and distortion of the spinal cord and interrupted fiber tracts. RESULTS FA and ADC both correlated with age in all three bilateral WM funiculi and GM, whereas FA and ADC ratios only showed correlation with age in the ventral funiculus (VF) and central GM. Differences were observed in ADC ratios and FA ratios from different Japanese Orthopedic Association (JOA) score subgroups and JOA recovery subgroups. For the three WM funiculi and GM, correlations between DTI ratios, JOA scores, and JOA recovery rates were consistently higher than those between DTI values, JOA scores, and JOA recovery rates (all P < 0.05). MRI grading was correlated with the JOA scores (r = -0.674, P < 0.001) but not JOA recovery rates (r = -0.197, P = 0.058), whereas DTT grading was correlated with both JOA scores (r = -0.813, P < 0.001) and JOA recovery rate (r = -0.429, P < 0.001). CONCLUSION DTI parameter ratios seemed to be less influenced by age than raw DTI results and could be more valuable than absolute DTI parameters for the evaluation of CSM. DTT grading is more valuable than MRI grading for diagnosis and prognostic prediction in CSM patients. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- Kun Wang
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhi Chen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fan Zhang
- Orthopedics Department, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingxin Song
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Canglong Hou
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yixing Tang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Jun Wang
- Orthopedics Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Shiyue Chen
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Yun Bian
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Qiang Hao
- Radiology Department, Changhai Hospital Affiliated to Second Military Medical University, Shanghai, China
| | - Hongxing Shen
- Orthopedics Department, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| |
Collapse
|
37
|
Efficacy of Diffusion Tensor Imaging Indices in Assessing Postoperative Neural Recovery in Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976) 2017; 42:8-13. [PMID: 27128391 DOI: 10.1097/brs.0000000000001667] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective observational cohort study. OBJECTIVE The aim of this study was to analyze the efficacy of diffusion tensor imaging (DTI) anisotropy indices in predicting the postoperative recovery in cervical spondylotic myelopathy (CSM) patients and to describe postoperative changes in the DTI indices based on neurological recovery after surgery. SUMMARY OF BACKGROUND DATA Surgical results of CSM are unpredictable and cannot be estimated based on preoperative MRI. DTI indices were found to have good sensitivity to detect changes in CSM, but their efficacy in predicting postoperative recovery and postoperative changes in DTI indices has not been studied before. METHODS Thirty-five patients who underwent surgical decompression for cervical spondylotic myelopathy underwent DTI evaluation preoperatively and postoperatively at 12 months. DTI indices-fractional anisotropy, apparent diffusion coefficient (ADC), relative anisotropy, volume ratio, and eigen vectors (E1, E2, and E3)-were obtained and clinical evaluations were made preoperatively and 12 months postoperatively. RESULTS Twenty-six patients were available for final follow-up at 12 months. Twenty patients showed improvement by at least 1 Nurick grade, five maintained the preoperative Nurick grade status and one patient was noted to have deterioration by 1 grade. The preoperative DTI values could not predict neurological recovery patterns postoperatively. Although conventional MRI showed adequate decompression in all patients irrespective of the clinical outcome, DTI indices showed variable results. There were significant improvements in postoperative DTI indices for ADC (P = 0.002), E1 (P < 0.001), and E2 (P = 0.012) values in patients who showed neurological recovery at 12 months. Postoperative DTI indices for coefficients ADC, E1, and E2 in neurologically static/worsened individuals remained unchanged or insignificant (P = 0.05) CONCLUSION.: The DTI indices were sensitive enough to indicate postoperative neurological recovery observed following surgery. Preoperative DTI evaluation could not predict postoperative recovery for patients with cervical spondylotic myelopathy. LEVEL OF EVIDENCE 4.
Collapse
|
38
|
Diffusion Tensor Imaging Correlates with Short-Term Myelopathy Outcome in Patients with Cervical Spondylotic Myelopathy. World Neurosurg 2017; 97:489-494. [DOI: 10.1016/j.wneu.2016.03.075] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/23/2022]
|
39
|
Zhang J, Cui C, Liu Z, Tong T, Niu R, Shen Y. Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: a multivariate analysis. Sci Rep 2016; 6:39512. [PMID: 27991596 PMCID: PMC5171638 DOI: 10.1038/srep39512] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 11/24/2016] [Indexed: 11/09/2022] Open
Abstract
The purpose of this study was to characterize risk factors for poor surgical outcome in patients with cervical spondylotic amyotrophy (CSA). We retrospectively reviewed 88 cases of CSA surgery and investigated age, sex, duration of symptoms, atrophy type, preoperative muscle power, signal changes on MRI, anterior horn (AH) or ventral nerve root (VNR) compression, compression levels, surgical approach and postoperative recovery. Fifty (56.8%) patients had good surgical outcome. Logistic regression, with poor outcome as dependent variable, showed independent risks associated with duration of symptoms (OR; 1 for symptom duration less than 3 months versus 3.961 [95% CI; 1.203–13.039, p = 0.024] for symptom duration of 3–6 months versus 18.724 [95% CI; 3.967–88.367, p < 0.001] for symptom duration greater than 6 months), compression type (OR; 1 for VNR versus 4.931 [95% CI; 1.457–16.685, p = 0.010] for AH versus 5.538 [95% CI; 1.170–26.218, p = 0.031] for VNR + AH), and atrophy type (OR; 1 for proximal type versus 6.456 [95% CI; 1.938–21.508, p = 0.002] for distal type). These findings suggest that a long duration of symptoms, AH or both AH and VNR compression, and distal type are risk factors for poor surgical outcome in patients with CSA.
Collapse
Affiliation(s)
- JingTao Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Can Cui
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Zhao Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Tong Tong
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - RuiJie Niu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yong Shen
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| |
Collapse
|
40
|
Fujiwara H, Makino T, Yonenobu K, Honda H, Kaito T. Correlations and time-dependent changes of upper arm performance tests, the Japanese Orthopaedic Association score, and a newly developed patient-based outcome measure : the Japanese Orthopaedic Cervical Myelopathy Questionnaire. Bone Joint J 2016; 98-B:990-6. [PMID: 27365479 DOI: 10.1302/0301-620x.98b7.37055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 03/04/2016] [Indexed: 11/05/2022]
Abstract
AIMS In this prospective observational study, we investigated the time-dependent changes and correlations of upper arm performance tests (ten-second test and Simple Test for Evaluating Hand Function (STEF), the Japanese Orthopaedic Association (JOA) score, and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) in 31 patients with cervical myelopathy who had undergone surgery. PATIENTS AND METHODS We hypothesised that all the indices correlate with each other, but show slightly different recovery patterns, and that the newly described JOACMEQ is a sensitive outcome measure. RESULTS Peak recoveries were achieved one month post-operatively in the ten-second test and JOACMEQ upper extremity function (UEF) subscale, and at three months in the JOA and STEF scores. The recoveries of all indices were maintained until six months post-operatively. The upper extremity function (UEF) subscale in the JOACMEQ showed the strongest correlation with STEF although all the indices correlated with each other. Patients with ≥ 20 and < 20 acquired points in the UEF subscale were classified into the UEF-improved and UEF-unimproved groups. Comparisons between the groups showed that pre-operative evaluation of "coordinated motion" of the STEF was significantly low in the UEF-unimproved group. CONCLUSION These results indicate that the JOACMEQ is a concise, sensitive, patient-based outcome measure for evaluating functional recovery in patients with cervical myelopathy who have undergone surgery. Cite this article: Bone Joint J 2016;98-B:990-6.
Collapse
Affiliation(s)
- H Fujiwara
- National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka 586-0008, Japan
| | - T Makino
- Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - K Yonenobu
- Graduate School of Health Care Sciences, Jikei institute, 1-2-8 Miyahara, Yodogawaku, Osaka 532-0003, Japan
| | - H Honda
- National Hospital Organization, Osaka Minami Medical Center, 2-1 Kidohigashi, Kawachinagano, Osaka 586-0008, Japan
| | - T Kaito
- Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| |
Collapse
|
41
|
Nakashima H, Tetreault LA, Nagoshi N, Nouri A, Kopjar B, Arnold PM, Bartels R, Defino H, Kale S, Zhou Q, Fehlings MG. Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients. J Neurol Neurosurg Psychiatry 2016; 87:734-40. [PMID: 26420885 PMCID: PMC4941131 DOI: 10.1136/jnnp-2015-311074] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 07/16/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND In general, older patients with degenerative cervical myelopathy (DCM) are felt to have lower recovery potential following surgery due to increased degenerative pathology, comorbidities, reduced physiological reserves and age-related changes to the spinal cord. This study aims to determine whether age truly is an independent predictor of surgical outcome and to provide evidence to guide practice and decision-making. METHODS A total of 479 patients with DCM were prospectively enrolled in the CSM-International study at 16 centres. Our sample was divided into a younger group (<65 years) and an elderly (≥65 years) group. A mixed model analytic approach was used to evaluate differences in the modified Japanese Orthopaedic Association (mJOA), Nurick, Short Form-36 (SF-36) and Neck Disability Index (NDI) scores between groups. We first created an unadjusted model between age and surgical outcome and then developed two adjusted models that accounted for variations in (1) baseline characteristics and (2) both baseline and surgical factors. RESULTS Of the 479 patients, 360 (75.16%) were <65 years and 119 (24.84%) were ≥65 years. Elderly patients had a worse preoperative health status (p<0.0001) and were functionally more severe (p<0.0001). The majority of younger patients (64.96%) underwent anterior surgery, whereas the preferred approach in the elderly group was posterior (58.62%, p<0.0001). Elderly patients had a greater number of decompressed levels than younger patients (p<0.0001). At 24 months after surgery, younger patients achieved a higher postoperative mJOA (p<0.0001) and a lower Nurick score (p<0.0001) than elderly patients. After adjustments for patient and surgical characteristics, these differences in postoperative outcome scores decreased but remained significant. CONCLUSIONS Older age is an independent predictor of functional status in patients with DCM. However, patients over 65 with DCM still achieve functionally significant improvement after surgical decompression.
Collapse
Affiliation(s)
- Hiroaki Nakashima
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Lindsay A Tetreault
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Narihito Nagoshi
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aria Nouri
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Branko Kopjar
- Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Paul M Arnold
- Department Neurosurgery, University of Kansas, Kansas City, Kansas, USA
| | - Ronald Bartels
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Helton Defino
- Faculty of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Shashank Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Qiang Zhou
- Department of Orthopedics, Third Military Medical University, Chongqing, China
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
42
|
Long-term results of anterior cervical corpectomy and fusion with nano-hydroxyapatite/polyamide 66 strut for cervical spondylotic myelopathy. Sci Rep 2016; 6:26751. [PMID: 27225189 PMCID: PMC4880938 DOI: 10.1038/srep26751] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/09/2016] [Indexed: 01/07/2023] Open
Abstract
To assess the long-term clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) with a neotype nano-hydroxyapatite/polyamide 66 (n-HA/PA66) strut in the treatment of cervical spondylotic myelopathy (CSM). Fifty patients with CSM who underwent 1- or 2-level ACCF with n-HA/PA66 struts were retrospectively investigated. With a mean follow-up of 79.6 months, the overall mean JOA score, VAS and cervical alignment were improved significantly. At last follow-up, the fusion rate was 98%, and the subsidence rate of the n-HA/PA66 strut was 8%. The "radiolucent gap" at the interface between the n-HA/PA66 strut and the vertebra was further noted to evaluate the osteoconductivity and osseointegration of the strut, and the incidence of it was 62% at the last follow-up. Three patients suffered symptomatic adjacent segment degeneration (ASD). No significant difference was detected in the outcomes between 1- and 2-level corpectomy at follow-ups. In conclusion, the satisfactory outcomes in this study indicated that the n-HA/PA66 strut was an effective graft for cervical reconstruction. Moreover, the osteoconductivity and osseointegration of the strut is still need to be optimized for future clinical application owing to the notably presence of "radiolucent gap" in present study.
Collapse
|
43
|
Risk factors for poor outcome of surgery for cervical spondylotic myelopathy. Spinal Cord 2016; 54:1127-1131. [DOI: 10.1038/sc.2016.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/19/2016] [Accepted: 03/19/2016] [Indexed: 11/09/2022]
|
44
|
Chang HK, Huang WC, Wu JC, Chang PY, Tu TH, Fay LY, Wu CL, Chang HC, Cheng H. Should Cervical Disc Arthroplasty Be Done on Patients with Increased Intramedullary Signal Intensity on Magnetic Resonance Imaging? World Neurosurg 2016; 89:489-96. [DOI: 10.1016/j.wneu.2016.02.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
|
45
|
Cervical Anterolisthesis: A Predictor of Poor Neurological Outcomes in Cervical Spondylotic Myelopathy Patients After Cervical Laminoplasty. Spine (Phila Pa 1976) 2016; 41:E467-73. [PMID: 27064337 DOI: 10.1097/brs.0000000000001277] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE To clarify the influence of cervical spondylolisthesis on neurological outcomes in cervical spondylotic myelopathy (CSM) patients after cervical laminoplasty. SUMMARY OF BACKGROUND DATA Studies focusing on the surgical outcomes in CSM patients with cervical spondylolisthesis are limited. METHODS We retrospectively reviewed 125 CSM patients after cervical laminoplasty. Neurological outcomes were evaluated by calculating the Japanese Orthopedic Association (JOA) recovery rate at 2 years after surgery. We defined anterolisthesis as a more than 3-mm anterior vertebral displacement in a flexion radiograph and retrolisthesis as a more than 3-mm posterior vertebral displacement in an extension radiograph. We further assessed potential risk factors for poor neurological outcomes after cervical laminoplasty, including cervical alignment, degree of spinal cord compression, duration of myelopathic symptoms, diabetes mellitus, and preoperative JOA score. Multivariate logistic regression analysis was performed to investigate the risk factors for poor outcomes (JOA recovery rate <50%) after cervical laminoplasty. RESULTS Our study included 86 men and 39 women with mean age of 64 (range, 30-89) years. Average JOA scores were 9.9 and 13.3 points before and at 2 years after surgery, respectively. Average recovery rate was 47.2% (range, -68% to 100%), with 62 patients having poor outcomes (JOA recovery rate <50%) at 2 years after surgery. Anterolisthesis and retrolisthesis were observed in 13 and 24 patients, respectively. Multivariate logistic regression analysis revealed that the anterolisthesis was a significant risk factor for poor outcomes (JOA recovery rate <50%) after cervical laminoplasty (P = 0.01), whereas retrolisthesis did not affect the neurological outcomes (P = 0.6). CONCLUSION Anterolisthesis, but not retrolisthesis, is a significant risk factor for and predictor of poor neurological outcomes after cervical laminoplasty. Cervical laminoplasty should not be considered in CSM patients with anterolisthesis. LEVEL OF EVIDENCE 2.
Collapse
|
46
|
Prognostic value of intraoperative MEP signal improvement during surgical treatment of cervical compressive myelopathy. 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 2016; 25:1875-80. [DOI: 10.1007/s00586-016-4477-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
|
47
|
Chen H, Pan J, Nisar M, Zeng HB, Dai LF, Lou C, Zhu SP, Dai B, Xiang GH. The value of preoperative magnetic resonance imaging in predicting postoperative recovery in patients with cervical spondylosis myelopathy: a meta-analysis. Clinics (Sao Paulo) 2016; 71:179-84. [PMID: 27074180 PMCID: PMC4785856 DOI: 10.6061/clinics/2016(03)10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 12/08/2015] [Indexed: 11/18/2022] Open
Abstract
This meta-analysis was designed to elucidate whether preoperative signal intensity changes could predict the surgical outcomes of patients with cervical spondylosis myelopathy on the basis of T1-weighted and T2-weighted magnetic resonance imaging images. We searched the Medline database and the Cochrane Central Register of Controlled Trials for this purpose and 10 studies meeting our inclusion criteria were identified. In total, 650 cervical spondylosis myelopathy patients with (+) or without (-) intramedullary signal changes on their T2-weighted images were examined. Weighted mean differences and 95% confidence intervals were used to summarize the data. Patients with focal and faint border changes in the intramedullary signal on T2 magnetic resonance imaging had similar Japanese Orthopaedic Association recovery ratios as those with no signal changes on the magnetic resonance imaging images of the spinal cord did. The surgical outcomes were poorer in the patients with both T2 intramedullary signal changes, especially when the signal changes were multisegmental and had a well-defined border and T1 intramedullary signal changes compared with those without intramedullary signal changes. Preoperative magnetic resonance imaging including T1 and T2 imaging can thus be used to predict postoperative recovery in cervical spondylosis myelopathy patients.
Collapse
Affiliation(s)
| | - Jun Pan
- corresponding author E-mail:
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Lee J, Koh SE, Jung H, Lee HY, Lee IS. Can MRI Findings Help to Predict Neurological Recovery in Paraplegics With Thoracolumbar Fracture? Ann Rehabil Med 2016; 39:922-30. [PMID: 26798606 PMCID: PMC4720768 DOI: 10.5535/arm.2015.39.6.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/17/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the usefulness of various magnetic resonance imaging (MRI) findings in the prognosis of neurological recovery in paraplegics with thoracolumbar fracture using association analysis with clinical outcomes and electrodiagnostic features. Methods This retrospective study involved 30 patients treated for paraplegia following thoracolumbar fracture. On axial and sagittal T2-weighted MRI scans, nerve root sedimentation sign, root aggregation sign, and signal intensity changes in the conus medullaris were independently assessed by two raters. A positive sedimentation sign was defined as the absence of nerve root sedimentation. The root aggregation sign was defined as the presence of root aggregation in at least one axial MRI scan. Clinical outcomes including the American Spinal Injury Association impairment scale, ambulatory capacity, and electrodiagnostic features were used for association analysis. Results Inter-rater reliability of the nerve root sedimentation sign and the root aggregation sign were κ=0.67 (p=0.001) and κ=0.78 (p<0.001), respectively. A positive sedimentation sign was significantly associated with recovery of ambulatory capacity after a rehabilitation program (χ2=4.854, p=0.028). The presence of the root aggregation sign was associated with reduced compound muscle action potential amplitude of common peroneal and tibial nerves in nerve conduction studies (χ2=5.026, p=0.025). Conclusion A positive sedimentation sign was significantly associated with recovery of ambulatory capacity and not indicative of persistent paralysis. The root aggregation sign suggested the existence of significant cauda equina injuries.
Collapse
Affiliation(s)
- Joonchul Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Heeyoune Jung
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - Hye Yeon Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine and Konkuk University Medical Center, Seoul, Korea
| |
Collapse
|
49
|
Chen X, Kong C, Feng S, Guan H, Yu Z, Cui L, Wang Y. Magnetic resonance diffusion tensor imaging of cervical spinal cord and lumbosacral enlargement in patients with cervical spondylotic myelopathy. J Magn Reson Imaging 2015; 43:1484-91. [PMID: 26620105 DOI: 10.1002/jmri.25109] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022] Open
Affiliation(s)
- Xueming Chen
- Department of Orthopedics; Beijing Luhe Hospital, Capital Medical University; Beijing China
| | - Chao Kong
- Department of Orthopedics; Beijing Luhe Hospital, Capital Medical University; Beijing China
| | - Shiqing Feng
- Department of Orthopedics; Tianjing Medical University General Hospital; Tianjing China
| | - Hua Guan
- Department of Orthopedics; China Rehabilitation Research Center; Beijing China
| | - Zhenshan Yu
- Department of Orthopedics; Beijing Luhe Hospital, Capital Medical University; Beijing China
| | - Libin Cui
- Department of Orthopedics; Beijing Luhe Hospital, Capital Medical University; Beijing China
| | - Yanhui Wang
- Department of Orthopedics; Beijing Luhe Hospital, Capital Medical University; Beijing China
| |
Collapse
|
50
|
Clinical significance of high intramedullary signal on T2-weighted cervical flexion-extension magnetic resonance imaging in cervical myelopathy. J Orthop Sci 2015; 20:973-7. [PMID: 26243328 DOI: 10.1007/s00776-015-0757-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 07/20/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND In cervical myelopathy, significant findings are seen in flexion-extension MRI due to the increased likelihood of cord compression during neck extension. In addition, a high intramedullary signal on T2-weighted MR images has been reported to be a prognostic factor in this condition. However, the relationship between Japanese Orthopaedic Association (JOA) scores and the signal intensity in preoperative cervical flexion-extension T2-weighted images has not been evaluated. The purpose of this study was to evaluate whether preoperative flexion-extension MRI may be used to predict surgical outcomes in patients with cervical myelopathy. METHODS A total of 121 patients who underwent surgery for cervical myelopathy were included. All patients underwent preoperative cervical flexion-extension MRI followed by cervical decompression surgery, with or without spinal fusion, and postoperative follow-up for at least 2 years. Pre- and postoperative (2 years after surgery) JOA scores were recorded, and the degree of postoperative improvement was calculated. The relationship between intramedullary signal intensity on preoperative cervical dynamic MRI findings and degree of clinical recovery was examined. RESULTS Patients with a high intramedullary signal on the extension MRI had significantly better neurological recovery than those with a high signal on the flexion MRI (p < 0.000005). There was no significant difference in neurological recovery between patients with and without a high intramedullary signal on extension MRI. CONCLUSIONS A preoperative high intramedullary signal on flexion MRI was associated with a poor surgical outcome, while no such association was seen with extension MRI.
Collapse
|