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Chiang TY, Wang YK, Huang WC, Huang SS, Chu YC. Intraoperative hypotension in non-emergency decompression surgery for cervical spondylosis: The role of chronic arterial hypertension. Front Med (Lausanne) 2022; 9:943596. [PMID: 36330062 PMCID: PMC9622940 DOI: 10.3389/fmed.2022.943596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Cervical spondylotic myelopathy and chronic hypertension show a cause-effect relationship. Hypertension increases cardiovascular risk and is associated with intraoperative hypotension. We aimed to evaluate intraoperative hypotension in patients undergoing non-emergency decompression surgery for cervical spondylosis and its association with clinical myelopathy and chronic arterial hypertension. Methods This retrospective cohort study used healthcare data of adult patients undergoing cervical spine surgeries at Taipei Veterans General Hospital from 2015 to 2019. The primary outcomes were the incidence of intraoperative hypotension and predictive factors, and the secondary outcomes were the association of intraoperative hypotension and postoperative adverse outcomes in the surgical population. Results Among the 1833 patients analyzed, 795 (43.4%) required vasopressor treatment and 342 (18.7%) showed persistent hypotension. Factors independent associated with hypotension after anesthetic induction were age [odds ratio (OR), 1.15; 95% confidence interval (CI), 1.07-1.23 per 5 years, P < 0.001], male sex (OR, 1.63; 95% CI, 1.21-2.19, P < 0.001), chronic hypertension (OR, 1.77; 95% CI, 1.32-2.38, P < 0.001), upper cervical spine level C0-2 treated (OR, 3.04; 95% CI, 1.92-4.84, P < 0.001 vs. C3-T1), and increased number of spine segments treated (OR, 1.43; 95% CI 1.26-1.63, P < 0.001). Patients who developed intraoperative hypotension experienced more acute postoperative kidney injury (OR, 7.90; 95% CI, 2.34–26.63, P < 0.001), greater need for intensive care (OR, 1.80; 95% CI, 1.24–2.60, P = 0.002), and longer admission after surgery (1.09 days longer, 95% CI 0.06-2.12, P = 0.038). Conclusion Intraoperative hypotension is common even in non-emergency cervical spine surgery. A history of hypertension independently predicted intraoperative hypotension. Prompt assessments for identifiable features can help ameliorate intraoperative hypotension.
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Affiliation(s)
- Ting-Yun Chiang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Yen-Kai Wang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Ya-Chun Chu,
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Davies BM, Munro C, Khan DZ, Fitzpatrick SM, Hilton B, Mowforth OD, McNair AGK, Sadler I, Kotter MRN. Outcomes of Degenerative Cervical Myelopathy From The Perspective of Persons Living With the Condition: Findings of a Semistructured Interview Process With Partnered Internet Survey. Global Spine J 2022; 12:432-440. [PMID: 33203262 PMCID: PMC9121154 DOI: 10.1177/2192568220953811] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
STUDY DESIGN Mixed-methods cross-sectional study. OBJECTIVES Degenerative cervical myelopathy (DCM) is a common and disabling condition. While classically, assessment and diagnosis has focused on neuromuscular symptoms, many other disabilities have been linked. The aim of this study was to explore the consequences of DCM for those with lived experience, producing a long list to inform the development of a core outcome set for DCM research. METHODS A 2-stage process was used: a focus group session of people with DCM (PwCM) and their supporters (n = 8) discussed the impact of DCM. This was used to develop a preliminary list of consequences, which were then placed into a survey of an online community of DCM sufferers (n = 224). Survey participants were asked to tick the consequences that they had experienced and given the opportunity to submit additional. Additional consequences were reviewed by a group of healthcare professionals and PwCM and included if not already represented. Demographic information including disease severity, age, and sex were captured for sampling comparison. RESULTS A total of 52 outcomes were identified from the focus group and nominally divided into 2 categories; symptoms (36 outcomes) and handicaps (18 outcomes), and further evaluated using a survey. All outcomes were recognized by at least 5% of respondents. A further 16 outcomes were added following the survey. CONCLUSIONS A list of DCM consequences has been defined from the perspective of PwCM. This will now be evaluated as part of AO Spine RECODE-DCM, an international multistakeholder collaboration to establish a core outcome set for research.
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Affiliation(s)
- Benjamin M. Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Colin Munro
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Danyal Z. Khan
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Danyal Z. Khan, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | - Bryn Hilton
- Colchester Hospital University, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Oliver D. Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Angus G. K. McNair
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Iwan Sadler
- Myelopathy Support, Myelopathy.org, Cambridge, UK
| | - Mark R. N. Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,WT MRC Cambridge Stem Cell Institute, Anne McLaren Laboratory, Cambridge, UK
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Davies BM, Mowforth O, Gharooni AA, Tetreault L, Nouri A, Dhillon RS, Bednarik J, Martin AR, Young A, Takahashi H, Boerger TF, Newcombe VFJ, Zipser CM, Freund P, Koljonen PA, Rodrigues-Pinto R, Rahimi-Movaghar V, Wilson JR, Kurpad SN, Fehlings MG, Kwon BK, Harrop JS, Guest JD, Curt A, Kotter MRN. A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time. Global Spine J 2022; 12:78S-96S. [PMID: 35174728 PMCID: PMC8859710 DOI: 10.1177/21925682211057546] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Literature Review (Narrative). OBJECTIVE To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. METHODS Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual's susceptibility, including the proposal of a new framework. RESULTS Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual's vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. CONCLUSION Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.
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Affiliation(s)
| | - Oliver Mowforth
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | | | - Lindsay Tetreault
- New York University, Langone Health, Graduate Medical Education, Department of Neurology, New York, NY, USA
| | - Aria Nouri
- Division of Neurosurgery, Geneva University Hospitals, University of Geneva, Genève, Switzerland
| | - Rana S. Dhillon
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Allan R. Martin
- Department of Neurosurgery, University of California Davis, Sacramento, CA, USA
| | - Adam Young
- Department of Neurosurgery, University of Cambridge, Cambridge, UK
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Virginia FJ Newcombe
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Carl Moritz Zipser
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick Freund
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - James D. Guest
- Department of Neurosurgery and the Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Armin Curt
- University Spine Center, Balgrist University Hospital, Zurich, Switzerland
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Garg K, Aggarwal A. Effect of Cervical Decompression on Atypical Symptoms Cervical Spondylosis-A Narrative Review and Meta-Analysis. World Neurosurg 2021; 157:207-217.e1. [PMID: 34655819 DOI: 10.1016/j.wneu.2021.09.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Atypical symptoms of cervical spondylosis refer to symptoms other than the typical symptoms of cervical spondylosis and include headache, nausea, gastrointestinal discomfort, blurred vision, tinnitus, hypomnesia, and palpitations. The role of cervical decompression in mitigating atypical symptoms of cervical spondylosis is still unclear. METHODS A comprehensive search of different databases was performed to retrieve articles that studied the effect of cervical decompression on associated atypical symptoms. The data were analyzed to obtain pooled improvement in the various atypical symptoms after cervical decompression. RESULTS Twenty-seven studies were included in the meta-analysis. Our analysis showed that cervical decompression was associated with significant improvement in Neck Disability Index-Headache Component (standardized mean difference [SMD], -0.84; 95% confidence interval [CI], -0.94 to -0.74; P < 0.0001), visual analog scale (SMD, -1.47; 95% CI, -1.73 to -1.21; P = 0.0004) and cervicogenic headache (odds ratio [OR], 0.19; 95% CI, 0.06-0.63; P = 0.01). Significant improvement was also observed in vertigo (OR, 0.27; 95% CI, 0.10-0.77; P = 0.02), tinnitus (OR, 0.54; 95% CI, 0.35-0.83; P = 0.02), and nausea (OR, 0.25; 95% CI, 0.13-0.47; P = 0.006) after cervical decompression. Nonsignificant improvement was noticed in the rates of blurred vision, hypomnesia, giddiness, gastrointestinal discomfort, palpitations, and hypertension. CONCLUSIONS Our analysis showed that cervicogenic headache, tinnitus, and nausea were significantly relieved after cervical decompression. There was no significant effect of cervical decompression on blurred vision, hypomnesia, giddiness gastrointestinal discomfort, palpitations, and hypertension.
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Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Ankita Aggarwal
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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Perdomo-Pantoja A, Chara A, Liu A, Jin Y, Taylor M, El Demerdash N, Ahmed AK, Pennington Z, Cottrill E, Westbroek EM, Bydon A, Theodore N, Witham TF. Surgical Decompression for Cervical Spondylotic Myelopathy in Patients with Associated Hypertension: A Single-Center Retrospective Cohort and Systematic Review of the Literature. World Neurosurg 2021; 155:e119-e130. [PMID: 34400323 DOI: 10.1016/j.wneu.2021.08.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/04/2021] [Accepted: 08/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore the relationship between spinal cord compression and hypertension through analysis of blood pressure (BP) variations in a cervical spondylotic myelopathy (CSM) cohort after surgical decompression, along with a review of the literature. METHODS A single-institution retrospective review of patients with CSM who underwent cervical decompression between 2016 and 2017 was conducted. Baseline clinical and imaging characteristics, preoperative and postoperative BP readings, heart rate, functional status, and pain scores were collected. In addition, a PRISMA guidelines-based systematic review was performed. RESULTS We identified 264 patients with CSM treated surgically; 149 (56.4%) of these had hypertension. The degree of spinal canal compromise and spinal cord compression, preoperative neurologic examination, and the presence of T2-signal hyperintensity on magnetic resonance imaging were associated with hypertension. Overall mean arterial pressure (MAP) decreased significantly at 1 and 12 months after surgery. Patients without T2-signal hyperintensity on imaging showed a MAP reduction at 12 months postoperatively, whereas those with T2-signal hyperintensity showed a transient MAP reduction at 1 month postoperatively before returning to preoperative values. At 12 months after surgery, 24 of 97 patients (24.7%) with initially uncontrolled hypertension had controlled BP values with significant reduction of MAP, systolic BP, and diastolic BP. Including the present study, 5 articles were eligible for systematic review, with all reporting a BP decrease in patients with CSM after decompression. CONCLUSIONS Analysis of our retrospective cohort and a systematic review suggest that cervical surgical decompression reduces BP in some patients with CSM. However, this improvement is less apparent in patients with preoperative spinal cord T2-signal hyperintensity.
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Affiliation(s)
| | - Alejandro Chara
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ann Liu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yike Jin
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maritza Taylor
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Nagat El Demerdash
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Erick M Westbroek
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Liu H, Wang HB, Yue L, Ma WG, Ploumis A, Gao LL, Wu YF. Effects of Decompressive Cervical Surgery on Blood Pressure in Cervical Spondylosis Patients With Hypertension: A Time Series Cohort Study. Int J Spine Surg 2021; 15:683-691. [PMID: 34266926 DOI: 10.14444/8090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The blood pressure of cervical spondylosis (CS) patients with hypertension often returns to normal after decompressive cervical surgery (DCS). However, the effect of DCS on the blood pressure of patients with CS has not been rigorously studied. METHODS We recruited 50 consecutive CS patients with hypertension from 2014-2017 and investigated the changes in blood pressure after DCS using a time series design. Ambulatory blood pressure monitoring (ABPM) was performed at 3 and 0 days before DCS and at 30 and 90 days after DCS. The primary outcome was mean 24-hour systolic blood pressure (SBP). Secondary outcomes included mean 24-hour diastolic blood pressure (DBP), office blood pressure, and the percentage of patients on antihypertensive medication. Paired t test was used for assessing the changes in blood pressure over time and a McNemar test was used for comparison among different medication groups. RESULTS The mean 24-hour SBP did not vary significantly among 4 time points (134.5 ± 14.7, 132.8 ± 14.7, 131.5 ± 13.3, and 133.2 ± 14.6, respectively; P = .42). The mean 24-hour DBP showed a similar trend. However, mean office SBP/DBP decreased significantly from 142.5/82.0 mm Hg before surgery to 127.3/76.6 mm Hg after surgery (both P < .01). The corresponding percentage of patients on antihypertensive medication decreased significantly, from 84% to 54% (P < .01). CONCLUSIONS This study confirmed previous findings of reduction in office blood pressure associated with DCS among CS patients with hypertension. However, this was not confirmed by multiple-time series of 24-hour ABPM. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Hong Liu
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Lei Yue
- Department of Orthopedic Surgery, Peking University First Hospital, Beijing, China
| | - Wei-Guo Ma
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing, China.,Aortic Institute at Yale-New Haven, Yale School of Medicine, New Haven, CT
| | - Avraam Ploumis
- Division of Orthopedics and Rehabilitation, Department of Surgery, University of Ioannina Medical School, Ioannina, Greece
| | - Ling-Ling Gao
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Yang-Feng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
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7
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Sharma R, Garg K, Agrawal S, Mishra S, Gurjar HK, Tandon V, Agrawal D, Singh M, Chandra SP, Kale SS. Atypical Symptoms of Cervical Spondylosis: Is Anterior Cervical Discectomy and Fusion Useful? - An Institutional Experience. Neurol India 2021; 69:595-601. [PMID: 34169849 DOI: 10.4103/0028-3886.317235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A significant proportion of patients with cervical spondylosis can present with atypical symptoms like vertigo, tinnitus, nausea, vomiting, headache, blurred vison, palpitations and gastrointestinal (GI) discomfort. The role of ACDF in alleviating these atypical symptoms remains unexplored. Objective The current study attempts to investigate the role of anterior cervical discectomy and fusion (ACDF) in alleviating atypical symptoms associated with cervical spondylosis. Materials and Methods The patients with cervical spondylosis who underwent ACDF between January 2011 and December 2015 were contacted by phone. Data regarding the severity and frequency of atypical symptoms was collected by a structured questionnaire. Wilcoxon signed rank test was used to compare the severity and frequency of these symptoms before the surgery and at last follow up. Results A total of 467 patients underwent ACDF for cervical spondylosis between January 2011 and December 2015, of which 358 patients were interviewed telephonically. 99 of 358 (27.65%) patients who met the eligibility criteria were included in the final analysis. The severity and frequency of vertigo, headache, nausea, vomiting and GI discomfort significantly improved at last follow-up (P < 0.001) compared to pre-operative period. Significant improvement in hypertension was also seen (P = 0.001). Improvements in severity and frequency of tinnitus (P = 0.083), palpitation (P = 0.317) and blurring of vision (P = 1.00) were not significant. Conclusions ACDF might improve the atypical symptoms like vertigo, headache, nausea, vomiting and GI discomfort in patients with cervical spondylosis. Some patients also show improvement in hypertension following surgery.
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Affiliation(s)
- Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agrawal
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh K Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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8
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Machino M, Ando K, Kobayashi K, Nakashima H, Kanbara S, Ito S, Inoue T, Koshimizu H, Ito K, Kato F, Imagama S. Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference. J Clin Neurosci 2020; 81:321-327. [PMID: 33222939 DOI: 10.1016/j.jocn.2020.09.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/13/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42-91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12-66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705-0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.
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Affiliation(s)
- Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Kanbara
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taro Inoue
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keigo Ito
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan.
| | - Fumihiko Kato
- Department of Orthopedic Surgery, Chubu Rosai Hospital, Japan Organization of Occupational Health and Safety, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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9
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Perdomo-Pantoja A, Chara A, Kalb S, Casaos J, Ahmed AK, Pennington Z, Cottrill E, Shah S, Jiang B, Manbachi A, Zygourakis C, Witham TF, Theodore N. The effect of renin-angiotensin system blockers on spinal cord dysfunction and imaging features of spinal cord compression in patients with symptomatic cervical spondylosis. Spine J 2020; 20:519-529. [PMID: 31821888 DOI: 10.1016/j.spinee.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/31/2019] [Accepted: 12/02/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical spondylosis may lead to spinal cord compression, poor vascular perfusion, and ultimately, cervical myelopathy. Studies suggest a neuroprotective effect of renin-angiotensin system (RAS) inhibitors in the brain, but limited data exist regarding their impact on the spinal cord. PURPOSE To investigate whether RAS blockers and other antihypertensive drugs are correlated with preoperative functional status and imaging markers of cord compression in patients with symptomatic cervical spondylosis. STUDY DESIGN Retrospective observational study. PATIENT SAMPLE Individuals with symptomatic degenerative cervical stenosis who underwent surgery. OUTCOME MEASURES Imaging features of spinal cord compression and functional status (modified Japanese Orthopedic Association [mJOA] and Nurick grading scales). METHODS Two hundred sixty-six operative patients with symptomatic degenerative cervical stenosis were included. Demographic data, comorbidities, antihypertensive medications, and functional status (including mJOA and Nurick grading scales) were collected. We evaluated canal compromise, cord compromise, surface area of T2 signal cord change, and pixel intensity of signal cord change compared with normal cord on T2-weighted magnetic resonance imaging sequences. RESULTS Of 266 patients, 41.7% were women, 58.3% were men; median age was 57.2 years; 20.6% smoked tobacco; 24.7% had diabetes mellitus. One hundred forty-nine patients (55.8%) had hypertension, 142 (95.3%) of these were taking antihypertensive medications (37 angiotensin-II receptor blockers [ARBs], 44 angiotensin-converting enzyme inhibitors, and 61 other medications). Patients treated with ARBs displayed a higher signal intensity ratio (ie, less signal intensity change in the compressed cord area) compared with untreated patients without hypertension (p=.004). Patients with hypertension had worse preoperative mJOA and Nurick scores than those without (p<.001). In the multivariate analysis, ARBs remained an independent beneficial factor for lower signal intensity change (p=.04), whereas hypertension remained a risk factor for worse preoperative neurological status (p<.01). CONCLUSIONS In our study, patients with hypertension who were treated with RAS inhibitors had decreased T2-weighted signal intensity change than untreated patients without hypertension. Patients with hypertension also had worse preoperative functional status. Prospective case-control studies may deepen understanding of RAS modulators in the imaging and functional status of chronic spinal cord compression.
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Affiliation(s)
| | - Alejandro Chara
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Samuel Kalb
- Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Joshua Casaos
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Zachary Pennington
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Ethan Cottrill
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Sohan Shah
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Amir Manbachi
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Corinna Zygourakis
- Department of Neurosurgery, Stanford University School Of Medicine, Stanford, CA, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins University School Of Medicine, Baltimore, MD, USA.
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Wang X, Ju J, Xu H. Nondrug therapies for hypertensive patients complicated with cervical spondylosis: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e19006. [PMID: 32000442 PMCID: PMC7004688 DOI: 10.1097/md.0000000000019006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to systematically evaluate the efficacy and safety of nondrug therapies for hypertensive patients complicated with cervical spondylosis. METHODS Randomized controlled trials (RCTs) concerned with nondrug therapies for hypertensive patients complicated with cervical spondylosis were identified by searching 5 English and Chinese databases. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 authors. RevMan 5.3 software was used for meta-analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI). RESULTS A total of 13 studies involving 929 patients were included. The majority of the included trials were assessed to be of high clinical heterogeneity and high risk of bias. The results of meta-analysis showed that there was a significant improvement in the effectiveness rate of cervical vertebra symptoms (RR = 1.67, 95% CI [1.33, 2.10], P < .0001), effectiveness rate of blood pressure lowering (RR = 1.35, 95% CI [1.06, 1.71], P = .02), systolic blood pressure reduction (MD = -11.05, 95% CI [-14.12, -7.98] mmHg, P < .0001), and diastolic blood pressure reduction (MD = -6.96, 95% CI [-8.89, -5.04] mmHg, P < .00001). Nondrug therapies had no significant difference compared with drugs in the effectiveness rate of overall improvement (RR = 1.3, 95% CI [0.93, 1.82], P = .12). There were no serious adverse effects related to nondrug therapies in the included trials. CONCLUSION The results show sound advantages of nondrug therapies over conventional medicine or sham procedure in efficacy. However, the evidence remains weak because of the high clinical heterogeneity and high risk of the included trials. Therefore, further thorough investigation, large-scale, proper-designed, randomized trials of nondrug therapies for hypertension complicated with cervical spondylosis are warranted. PROSPERO REGISTRATION NUMBER CRD2019123175.
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Affiliation(s)
- Xinyi Wang
- Graduate School, Beijing University of Chinese Medicine
| | - Jianqing Ju
- Xiyuan Hospital, China Academy of Chinese Medical Sciences
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
| | - Hao Xu
- Xiyuan Hospital, China Academy of Chinese Medical Sciences
- National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China
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Li P, Wei Z, Zhang H, Zhang K, Li J. Effects of decompressive operation on cardiac autonomic regulation in patients with cervical spondylotic myelopathy: analysis of blood pressure, heart rate, and heart rate variability. 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 2019; 28:1864-1871. [DOI: 10.1007/s00586-019-05972-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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Zhang J, Liu H, Bou EH, Jiang W, Zhou F, He F, Yang H, Liu T. Comparative Study Between Anterior Cervical Discectomy and Fusion with ROI-C Cage and Laminoplasty for Multilevel Cervical Spondylotic Myelopathy without Spinal Stenosis. World Neurosurg 2019; 121:e917-e924. [DOI: 10.1016/j.wneu.2018.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/29/2018] [Accepted: 10/02/2018] [Indexed: 12/17/2022]
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