1
|
The Essence of Clinical Practice Guidelines for Cervical Spondylotic Myelopathy, 2020. Spine Surg Relat Res 2024; 8:119-132. [PMID: 38618212 PMCID: PMC11007242 DOI: 10.22603/ssrr.2022-0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 04/16/2024] Open
|
2
|
Hejrati N, Pedro K, Alvi MA, Quddusi A, Fehlings MG. Degenerative cervical myelopathy: Where have we been? Where are we now? Where are we going? Acta Neurochir (Wien) 2023; 165:1105-1119. [PMID: 37004568 DOI: 10.1007/s00701-023-05558-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/06/2023] [Indexed: 04/04/2023]
Abstract
Degenerative cervical myelopathy (DCM), a recently coined term, encompasses a group of age-related and genetically associated pathologies that affect the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Given the significant contribution of DCM to global disease and disability, there are worldwide efforts to promote research and innovation in this area. An AO Spine effort termed 'RECODE-DCM' was initiated to create an international multistakeholder consensus group, involving patients, caregivers, physicians and researchers, to focus on launching actionable discourse on DCM. In order to improve the management, treatment and results for DCM, the RECODE-DCM consensus group recently identified ten priority areas for translational research. The current article summarizes recent advancements in the field of DCM. We first discuss the comprehensive definition recently refined by the RECODE-DCM group, including steps taken to arrive at this definition and the supporting rationale. We then provide an overview of the recent advancements in our understanding of the pathophysiology of DCM and modalities to clinically assess and diagnose DCM. A focus will be set on advanced imaging techniques that may offer the opportunity to improve characterization and diagnosis of DCM. A summary of treatment modalities, including surgical and nonoperative options, is then provided along with future neuroprotective and neuroregenerative strategies. This review concludes with final remarks pertaining to the genetics involved in DCM and the opportunity to leverage this knowledge toward a personalized medicine approach.
Collapse
Affiliation(s)
- Nader Hejrati
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Karlo Pedro
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mohammed Ali Alvi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Ayesha Quddusi
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Genetics and Development, Krembil Research Institute, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada.
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
3
|
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.
Collapse
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
| | | |
Collapse
|
4
|
Marie-Hardy L, Pascal-Moussellard H. Degenerative cervical myelopathy. Rev Neurol (Paris) 2021; 177:490-497. [PMID: 33781560 DOI: 10.1016/j.neurol.2020.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/25/2020] [Accepted: 11/26/2020] [Indexed: 10/21/2022]
Abstract
Degenerative cervical myelopathy (DCM) frequently leads to severe neurologic disability but is still frequently underdiagnosed. One explanation may be the variability of the symptoms presented by the patients, from paresthesia to quadriplegia, making it another great masquerader. What do we know? How can we manage better these patients? We will review the keys points concerning its challenging diagnosis (clinical and radiologic), some of the recent discoveries about DCM, notably the underlying genetic mutations identified, linked to its pathophysiology, before addressing the consensual points concerning its management and the major evolutive risk: acute decompensation.
Collapse
Affiliation(s)
- L Marie-Hardy
- Orthopaedic surgery department, Pitié-Salpétrière hospital, 47, boulevard de l'Hôpital, 75013 Paris, France.
| | - H Pascal-Moussellard
- Orthopaedic surgery department, Pitié-Salpétrière hospital, 47, boulevard de l'Hôpital, 75013 Paris, France
| |
Collapse
|
5
|
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
|
6
|
Pope DH, Davies BM, Mowforth OD, Bowden AR, Kotter MRN. Genetics of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis of Candidate Gene Studies. J Clin Med 2020; 9:jcm9010282. [PMID: 31968564 PMCID: PMC7019856 DOI: 10.3390/jcm9010282] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 12/20/2019] [Accepted: 01/14/2020] [Indexed: 01/22/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is estimated to be the most common cause of adult spinal cord impairment. Evidence that is suggestive of a genetic basis to DCM has been increasing over the last decade. A systematic search was conducted in MEDLINE, EMBASE, Cochrane, and HuGENet databases from their origin up to 14th December 2019 to evaluate the role of single genes in DCM in its onset, clinical phenotype, and response to surgical intervention. The initial search yielded 914 articles, with 39 articles being identified as eligible after screening. We distinguish between those contributing to spinal column deterioration and those contributing to spinal cord deterioration in assessing the evidence of genetic contributions to DCM. Evidence regarding a total of 28 candidate genes was identified. Of these, 22 were found to have an effect on the radiological onset of spinal column disease, while 12 genes had an effect on clinical onset of spinal cord disease. Polymorphisms of eight genes were found to have an effect on the radiological severity of DCM, while three genes had an effect on clinical severity. Polymorphisms of six genes were found to have an effect on clinical response to surgery in spinal cord disease. There are clear genetic effects on the development of spinal pathology, the central nervous system (CNS) response to bony pathology, the severity of both bony and cord pathology, and the subsequent response to surgical intervention. Work to disentangle the mechanisms by which the genes that are reviewed here exert their effects, as well as improved quality of evidence across diverse populations is required for further investigating the genetic contribution to DCM.
Collapse
Affiliation(s)
- Daniel H. Pope
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - Benjamin M. Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Oliver D. Mowforth
- School of Clinical Medicine, University of Cambridge, Cambridge CB2 0SP, UK
| | - A. Ramsay Bowden
- Department of Clinical Genetics, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- The Wellcome Trust/Cancer Research UK Gurdon Institute and Department of Biochemistry, University of Cambridge, Cambridge CB2 1QN, UK
| | - Mark R. N. Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0QQ, UK
- Anne McLaren Laboratory for Regenerative Medicine, Wellcome-MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0SZ, UK
- Correspondence: ; Tel.: +44-122-376-3366
| |
Collapse
|
7
|
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
|
8
|
Song DW, Wu YD, Tian DD. Association of VDR-FokI and VDBP-Thr420Lys polymorphisms with cervical spondylotic myelopathy: A case-control study in the population of China. J Clin Lab Anal 2018; 33:e22669. [PMID: 30461062 DOI: 10.1002/jcla.22669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM), a common degenerative disorder, is characterized by chronic progressive compression of the cervical spinal cord. The present case-control study aimed to explore the potential role of VDR-FokI and VDBP-Thr420Lys polymorphisms in the susceptibility to CSM in the Chinese population. METHODS The study enrolled 318 CSM patients and 282 healthy individuals whose clinical data were retrospectively analyzed. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis was used to genotype VDR-FokI and VDBP-Thr420Lys polymorphisms. The severity of CSM was assessed using the Japanese Orthopaedic Association (JOA) score with magnetic resonance imaging (MRI) of cervical vertebra. A nonconditional binary logistic regression model was conducted for assessing the risk factors of CSM. RESULTS Patients in the CSM group had longer time duration to bend over desk working than the control group. The ff genotype and f allele frequency of VDR-FokI were elevated in CSM patients. Elevated Ff + ff genotype and f allele frequency of VDR-FokI might increase the risk of CSM. The VDR-FokI polymorphism was associated with nucleus pulposus capillary invasion, necrosis, hyaline degeneration and fibrosis, genesis and hyperplasia of cartilage-like cells, and fibrocyst in the fibrous ring. The VDR-FokI and VDBP-Thr420Lys genotypes conformed to Hardy-Weinberg equilibrium which showed that VDR-FokI and VDBP-Thr420Lys had group representation characteristics. CONCLUSION Binary logistic regression analysis confirmed that VDR-FokI polymorphism and the time to bend over desk working were risk factors of CSM. Our results indicate that VDR-FokI polymorphism may be closely associated with the risk of CSM.
Collapse
Affiliation(s)
- De-Wei Song
- Department of Pain, the People's Hospital of Mengyin County, Mengyin, China
| | - Yu-Dong Wu
- Department of Pain, the People's Hospital of Mengyin County, Mengyin, China
| | - Dong-Dong Tian
- Department of Pain, the People's Hospital of Mengyin County, Mengyin, China
| |
Collapse
|
9
|
Yu HM, Chen XL, Wei W, Yao XD, Sun JQ, Su XT, Lin SF. Effect of osteoprotegerin gene polymorphisms on the risk of cervical spondylotic myelopathy in a Chinese population. Clin Neurol Neurosurg 2018; 175:149-154. [PMID: 30447607 DOI: 10.1016/j.clineuro.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 08/13/2018] [Accepted: 09/05/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction. Our study aims to explore the correlation of osteoprotegerin (OPG) gene polymorphisms and the risk factors and severity of CSM. PATIENTS AND METHODS The peripheral blood samples from 494 CSM patients and 515 healthy individuals were collected for detecting the 950T/C, 1181G/C and 163A/G genotypes and genetic equilibrium of OPG in the CSM and control groups and analyzing the genotype distribution and allele frequency. The severity of CSM and the impaired segments were evaluated by the Japanese Orthopedic Association (JOA) scoring combined with cervical magnetic resonance imaging (MRI), in order to investigate the relations between the three genotypes of OPG promoter gene loci (950T/C, 163A/G and 1181G/C) and occurrence as well as severity of CSM. RESULTS The risk rate of TC genotype carrier suffered from CSM was 0.46, of TT genotype carrier was 0.27. The risk rate of T allele carrier suffered from CSM was 0.37. In 950T/C single nucleotide polymorphism (SNP), patients with TC, TT and T genotypes had lower risk to suffer from CSM. CONCLUSION Taken together, OPG 950T/C SNP protects against CSM, and it is correlated with the severity of CSM, providing a new idea for the prevention and treatment of CSM.
Collapse
Affiliation(s)
- Hai-Ming Yu
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, PR China.
| | - Xiao-Lei Chen
- Department of Orthopedics, The Second People's Hospital of Henan Province, Zhengzhou, 451191, PR China
| | - Wu Wei
- The First Department of Orthopedics, Wuzhou Red Cross Hospital of Guangxi, Wuzhou, 543002, PR China
| | - Xue-Dong Yao
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, PR China
| | - Jing-Qun Sun
- Department of Orthopaedics, The Third Hospital of Xiamen, Xiamen, 361100, PR China
| | - Xiao-Tao Su
- Affiliated NanHua Hospital, University of South China, Hengyang, 421002, PR China
| | - Shu-Feng Lin
- Department of Orthopaedics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, PR China
| |
Collapse
|
10
|
Wang G, Cao Y, Wu T, Duan C, Wu J, Hu J, Lu H. Genetic factors of cervical spondylotic myelopathy-a systemic review. J Clin Neurosci 2017; 44:89-94. [PMID: 28734792 DOI: 10.1016/j.jocn.2017.06.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 06/19/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) is a degenerative disorder of the neck. Recent studies have reported the roles of single nucleotide polymorphisms and abnormal gene expression in the etiology and development of CSM. However, a systemic review of these findings is currently unavailable. METHODS A systemic review of genetic factors of CSM was conducted through searching PubMed and EMbase databases. A total of 9 studies were included in this study, which included 8 genes: brain derived neurotrophic factor (BDNF), osteopontin (OPN), bone morphogenic protein (BMP) 4, collagen IX, vitamin D receptor (VDR), apolipoprotein E (ApoE), hypoxia-inducible factor α (HIF-1α), and cyclooxygenase 2 (COX-2). RESULTS The polymorphisms of 6 genes (OPN, BMP-4, collagen IX, VDR, HIF-1α) showed significant association with the susceptibility to or risk of CSM. The polymorphisms of 3 genes (BMP-4, ApoE4, HIF-1α) were significantly associated with the postoperative outcome. The polymorphism of BDNF, VDR, and expression of COX-2 were associated with the severity of disease. CONCLUSION This review demonstrates that 8 genes were associated with CSM although there is no repeated study. This review also suggests that large scale and high quality studies are needed to provide more reliable evidence for future evaluation.
Collapse
Affiliation(s)
- Guohua Wang
- Department of Spine Surgery, The First Affiliated Hospital (Hunan Provincial People's Hospital), Hunan Normal University, Changsha, Hunan 410005, People's Republic of China; Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yong Cao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Tianding Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Chunyue Duan
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Jianhuang Wu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Jianzhong Hu
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China.
| | - Hongbin Lu
- Department of Sport Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China.
| |
Collapse
|
11
|
Abode-Iyamah KO, Stoner KE, Grossbach AJ, Viljoen SV, McHenry CL, Petrie MA, Dahdaleh NS, Grosland NM, Shields RK, Howard MA. Effects of brain derived neurotrophic factor Val66Met polymorphism in patients with cervical spondylotic myelopathy. J Clin Neurosci 2015; 24:117-21. [PMID: 26461908 DOI: 10.1016/j.jocn.2015.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 07/18/2015] [Indexed: 11/29/2022]
Abstract
Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord related disability in the elderly. It results from degenerative narrowing of the spinal canal, which causes spinal cord compression. This leads to gait instability, loss of dexterity, weakness, numbness and urinary dysfunction. There has been indirect data that implicates a genetic component to CSM. Such a finding may contribute to the variety in presentation and outcome in this patient population. The Val66Met polymorphism, a mutation in the brain derived neurotrophic factor (BDNF) gene, has been implicated in a number of brain and psychological conditions, and here we investigate its role in CSM. Ten subjects diagnosed with CSM were enrolled in this prospective study. Baseline clinical evaluation using the modified Japanese Orthopaedic Association (mJOA) scale, Nurick and 36-Item Short Form Health Survey (SF-36) were collected. Each subject underwent objective testing with gait kinematics, as well as hand functioning using the Purdue Peg Board. Blood samples were analyzed for the BDNF Val66Met mutation. The prevalence of the Val66Met mutation in this study was 60% amongst CSM patients compared to 32% in the general population. Individuals with abnormal Met allele had worse baseline mJOA and Nurick scores. Moreover, baseline gait kinematics and hand functioning testing were worse compared to their wild type counterpart. BDNF Val66Met mutation has a higher prevalence in CSM compared to the general population. Those with BDNF mutation have a worse clinical presentation compared to the wild type counterpart. These findings suggest implication of the BDNF mutation in the development and severity of CSM.
Collapse
Affiliation(s)
- Kingsley O Abode-Iyamah
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52245, USA.
| | - Kirsten E Stoner
- Department of Bioengineering, The University of Iowa, Iowa City, IA, USA
| | - Andrew J Grossbach
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52245, USA
| | - Stephanus V Viljoen
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52245, USA
| | - Colleen L McHenry
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Michael A Petrie
- Department of Physical Therapy and Rehabilitation Science, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA
| | - Nader S Dahdaleh
- Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Nicole M Grosland
- Department of Bioengineering, The University of Iowa, Iowa City, IA, USA
| | - Richard K Shields
- Department of Bioengineering, The University of Iowa, Iowa City, IA, USA; Department of Veterans Affairs, VA Medical Center, Iowa City, IA, USA
| | - Matthew A Howard
- Department of Neurosurgery, Carver College of Medicine, The University of Iowa, 200 Hawkins Drive, Iowa City, IA 52245, USA
| |
Collapse
|
12
|
Wang ZC, Hou XW, Shao J, Ji YJ, Li L, Zhou Q, Yu SM, Mao YL, Zhang HJ, Zhang PC, Lu H. HIF-1α polymorphism in the susceptibility of cervical spondylotic myelopathy and its outcome after anterior cervical corpectomy and fusion treatment. PLoS One 2014; 9:e110862. [PMID: 25401740 PMCID: PMC4234507 DOI: 10.1371/journal.pone.0110862] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/24/2014] [Indexed: 02/06/2023] Open
Abstract
Background To investigate the association between the single nucleotide polymorphism (SNP) of hypoxia-inducible factor1 α (HIF-1α) and the susceptibility to cervical spondylotic myelopathy (CSM) and its outcome after surgical treatment. Method A total of 230 CSM patients and 284 healthy controls were recruited. All patients received anterior cervical corpectomy and fusion (ACF) and were followed for 12 months. The genotypes for two HIF-1α variants (1772C>T and 1790G>A) were determined. Results In the present study, we found that the HIF-1α polymorphism at 1790G>A significantly affects the susceptibility to CSM and its clinical features, including severity and onset age. In addition, the 1790A>G polymorphism also determines the prognosis of CSM patients after ACF treatment. The GG genotype of 1790G>A polymorphism is associated with a higher risk to develop CSM, higher severity and earlier onset age. More importantly, we found that the 1790G>A polymorphism determines the clinical outcome in CSM patients who underwent ACF treatment. Conclusion Our findings suggest that the HIF-1α 1790G>A polymorphism is associated with the susceptibility to CSM and can be used as predictor for the clinical outcome in CSM patients receiving ACF treatment.
Collapse
Affiliation(s)
- Zhan-Chao Wang
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Xu-Wei Hou
- Department of Cardiology, Hangzhou Hospital, Nanjing Medical University & Hangzhou First Municipal Hospital, Hangzhou, China
| | - Jiang Shao
- Department of Orthopedics, Xinhua Hospital, Shanghai Jiaotong University; Shanghai, China
| | - Yong-Jing Ji
- Department of Internal Medicine, Jinan 2nd People's Hospital, Jinan, China
| | - Lulu Li
- Department of Biostatistics, College of Public Health, Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Qiang Zhou
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Si-Ming Yu
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Yu-Lun Mao
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Hao-Jie Zhang
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Ping-Chao Zhang
- Department of Orthopedics, Xinhua Hospital (Chongming), Shanghai Jiaotong University, Shanghai, China
| | - Hua Lu
- Department of Orthopedics, Xinhua Hospital, Shanghai Jiaotong University; Shanghai, China
- * E-mail:
| |
Collapse
|