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Vitale SG, De Angelis MC, Della Corte L, Saponara S, Carugno J, Laganà AS, Török P, Tinelli R, Pérez-Medina T, Ertas S, Urman B, Angioni S. Uterine cervical stenosis: from classification to advances in management. Overcoming the obstacles to access the uterine cavity. Arch Gynecol Obstet 2024; 309:755-764. [PMID: 37428263 PMCID: PMC10866788 DOI: 10.1007/s00404-023-07126-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/20/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND To date hysteroscopy is the gold standard technique for the evaluation and management of intrauterine pathologies. The cervical canal represents the access route to the uterine cavity. The presence of cervical stenosis often makes entry into the uterine cavity difficult and occasionally impossible. Cervical stenosis has a multifactorial etiology. It is the result of adhesion processes that can lead to the narrowing or total obliteration of the cervical canal. PURPOSE In this review, we summarize the scientific evidence about cervical stenosis, aiming to identify the best strategy to overcome this challenging condition. METHODS The literature review followed the scale for the quality assessment of narrative review articles (SANRA). All articles describing the hysteroscopic management of cervical stenosis were considered eligible. Only original papers that reported data on the topic were included. RESULTS Various strategies have been proposed to address cervical stenosis, including surgical and non-surgical methods. Medical treatments such as the preprocedural use of cervical-ripening agents or osmotic dilators have been explored. Surgical options include the use of cervical dilators and hysteroscopic treatments. CONCLUSIONS Cervical stenosis can present challenges in achieving successful intrauterine procedures. Operative hysteroscopy has been shown to have the highest success rate, particularly in cases of severe cervical stenosis, and is currently considered the gold standard for managing this condition. Despite the availability of miniaturized instruments that have made the management of cervical stenosis more feasible, it remains a complex task, even for experienced hysteroscopists.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Maria Chiara De Angelis
- Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Stefania Saponara
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - Jose Carugno
- Division of Minimally Invasive Gynecology, Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico-Di Cristina-Benfratelli", Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Péter Török
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Raffaele Tinelli
- Department of Obstetrics and Gynecology, "Valle d'Itria" Hospital, Martina Franca, Taranto, Italy
| | - Tirso Pérez-Medina
- Department of Obstetrics and Gynecology, University Hospital Puerta de Hierro Majadahonda, Autónoma University of Madrid, Madrid, Spain
| | - Sinem Ertas
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Bulent Urman
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Lee Y, Heard JC, Lambrechts MJ, Kern N, Wiafe B, Goodman P, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Hilibrand AS, Vaccaro AR, Kepler CK, Schroeder GD, Rihn JA. Significance of Facet Fluid Index in Anterior Cervical Degenerative Spondylolisthesis. Asian Spine J 2024; 18:94-100. [PMID: 38287666 PMCID: PMC10910141 DOI: 10.31616/asj.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 01/31/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. PURPOSE To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on. OVERVIEW OF LITERATURE The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis. METHODS Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and manual chart review. Radiographic measurements were made on preoperative MRIs for all vertebral levels diagnosed with spondylolisthesis and adjacent undiagnosed levels between C3 and C6. The facet fluid index was calculated by dividing the facet fluid measurement by the width of the facet. Bivariate analysis was conducted to compare facet characteristics based on radiographic spondylolisthesis and spondylolisthesis stability. RESULTS We included 154 patients, for whom 149 levels were classified as having spondylolisthesis and 206 levels did not. The average facet fluid index was significantly higher in patients with spondylolisthesis (0.26±0.07 vs. 0.23±0.08, p <0.001). In addition, both fluid width and facet width were significantly larger in patients with spondylolisthesis (p <0.001 each). Cervical levels in the fusion construct demonstrated a greater facet fluid index and were more likely to have unstable spondylolisthesis than stable spondylolisthesis (p <0.001 each). CONCLUSIONS Facet fluid index is associated with cervical spondylolisthesis and an increased facet size and fluid width are associated with unstable spondylolisthesis. While cervical spondylolisthesis continues to be an inconclusive finding, vertebral levels with spondylolisthesis, especially the unstable ones, were more likely to be included in the fusion procedure than those without spondylolisthesis.
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Affiliation(s)
- Yunsoo Lee
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeremy C. Heard
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO,
USA
| | - Nathaniel Kern
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Bright Wiafe
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Perry Goodman
- Sydney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - John J. Mangan
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Mark F. Kurd
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Ian D. Kaye
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA,
USA
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3
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Elliott L, Li M, Gharooni AA, Davies BM, Mowforth OD. Respiratory dysfunction in degenerative cervical myelopathy: A systematic review. J Clin Neurosci 2024; 120:94-101. [PMID: 38237493 DOI: 10.1016/j.jocn.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Degenerative cervical myelopathy is a condition of symptomatic cervical spinal cord compression secondary to a range of degenerative spinal pathology. Respiratory symptoms such as shortness of breath are not uncommonly reported by people with DCM and respiratory dysfunction has been described in several DCM studies. The objective of this review was therefore to systematically synthesise the current evidence on the relationship between DCM and respiratory function. METHODS The review was registered on PROSPERO and adhered to PRISMA guidelines. Ovid MEDLINE and Embase were searched from inception to 14th March 2023. DCM studies reporting on any measure or outcome relating to respiratory function or disease were eligible. Reference lists of included studies and relevant reviews articles were hand searched. Title, abstract and full text screening, risk of bias and GRADE assessments were completed in duplicate. A quantitative synthesis is presented. RESULTS Of 1991 studies identified by literature searching, 13 met inclusion criteria: 3 cohort studies, 5 case-control studies, 1 case series and 4 case studies. Forced vital capacity (FVC), peak expiratory flow rate (PEFR) and maximal voluntary ventilation (MVV) were reported to be lower in DCM patients than controls; there was inconsistency in comparisons of forced expiratory volume in 1 s (FEV1). There was conflicting evidence on whether surgical decompression was associated with improvements in respiratory parameters and on the relationship between level of spinal cord compression and respiratory dysfunction. CONCLUSION DCM may be associated with respiratory dysfunction. However, consistency and quality of evidence is currently low. Further work should characterise respiratory dysfunction in DCM patients more rigorously and investigate putative mechanisms such as disruption to cervical nerve roots responsible for diaphragmatic innervation and damage to descending spinal projections from brainstem respiratory centres.
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Affiliation(s)
- Lorcan Elliott
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael Li
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aref-Ali Gharooni
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Division of Academic Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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Azzi PA, Bastos Russomano F, de Andrade CV, de Camargo MJ, Moskovics Jordão P. Frequency of post-treatment disease after excisional procedure in stage IA1 squamous cervical carcinoma - a case series. Women Health 2023; 63:747-755. [PMID: 37779317 DOI: 10.1080/03630242.2023.2264398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/24/2023] [Indexed: 10/03/2023]
Abstract
Early stages of cervical cancer in young women need conservative treatments. Electrosurgical therapies (LLETZ, LEEP, SWETZ, NETZ) have been recommended for these women. However, there are recommendations to perform a second excision when the specimen margins are not free of disease. This can lead to some important complications. This article aims to verify the frequency of residual invasive or microinvasive disease after the excisional procedure in women with IA1CC. Data on women with IA1CC diagnosed between 1990 and 2022, were retrieved from medical records. Post-treatment disease was detected during a second surgical procedure or postoperative follow-up. Among the 69 included women, three (4.3 percent; CI95 percent 0-9.2) had residual microinvasive lesions, while none showed invasive disease during a second procedure or follow-up. Only the age of 37 years or more was significantly related to the presence of preinvasive or microinvasive residual lesions. Nearly 80 percent of the women who underwent a second procedure showed no residual lesions. The absence of invasive disease in a second procedure or during the follow-up of these women and the large proportion of women with no residual lesion questions the need for a new surgical procedure even when the surgical margins of the initial specimen are involved.
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Affiliation(s)
- Pedro Abreu Azzi
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Fábio Bastos Russomano
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Cecilia Vianna de Andrade
- Laboratory of Pathology and Cytopathology, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria José de Camargo
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Paula Moskovics Jordão
- Women's Health Care Area, Colposcopy Unit, Institute of Woman, Child and Adolescent's Health Fernandes Figueira, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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Das A, Vazquez S, Stein A, Greisman JD, Ng C, Ming T, Vaserman G, Spirollari E, Naftchi AF, Dominguez JF, Hanft SJ, Houten J, Kinon MD. Disparities in anterior cervical discectomy and fusion provision and outcomes for cervical stenosis. N Am Spine Soc J 2023; 14:100217. [PMID: 37214264 PMCID: PMC10192645 DOI: 10.1016/j.xnsj.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023]
Abstract
Background Disparities in neurosurgical care have emerged as an area of interest when considering the impact of social determinants on access to health care. Decompression via anterior cervical discectomy and fusion (ACDF) for cervical stenosis (CS) may prevent progression towards debilitating complications that may severely compromise one's quality of life. This retrospective database analysis aims to elucidate demographic and socioeconomic trends in ACDF provision and outcomes of CS-related pathologies. Methods The Healthcare Cost and Utilization Project National Inpatient Sample database was queried between 2016 and 2019 using International Classification of Diseases 10th edition codes for patients undergoing ACDF as a treatment for spinal cord and nerve root compression. Baseline demographics and inpatient stay measures were analyzed. Results Patients of White race were significantly less likely to present with manifestations of CS such as myelopathy, plegia, and bowel-bladder dysfunction. Meanwhile, Black patients and Hispanic patients were significantly more likely to experience these impairments representative of the more severe stages of the degenerative spine disease process. White race conferred a lesser risk of complications such as tracheostomy, pneumonia, and acute kidney injury in comparison to non-white race. Insurance by Medicaid and Medicare conferred significant risks in terms of more advanced disease prior to intervention and negative inpatient. Patients in the highest quartile of median income consistently fared better than patients in the lowest quartile across almost every aspect ranging from degree of progression at initial presentation to incidence of complications to healthcare resource utilization. All outcomes for patients age > 65 were worse than patients who were younger at the time of the intervention. Conclusions Significant disparities exist in the trajectory of CS and the risks associated with ACDF amongst various demographic cohorts. The differences between patient populations may be reflective of a larger additive burden for certain populations, especially when considering patients' intersectionality.
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Affiliation(s)
- Ankita Das
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Sima Vazquez
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - Jacob D. Greisman
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Christina Ng
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Tiffany Ming
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Grigori Vaserman
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Eris Spirollari
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Alexandria F. Naftchi
- School of Medicine, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, United States
| | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - Simon J. Hanft
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
| | - John Houten
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, New York, NY 10029, United States
| | - Merritt D. Kinon
- Department of Neurosurgery, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, United States
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Mowforth OD, Burn L, Khan DZ, Yang X, Stacpoole SRL, Gronlund T, Tetreault L, Kalsi-Ryan S, Starkey ML, Sadler I, Sarewitz E, Houlton D, Carter J, Howard P, Rahimi-Movaghar V, Guest JD, Aarabi B, Kwon BK, Kurpad SN, Harrop J, Wilson JR, Grossman R, Smith EK, McNair A, Fehlings MG, Kotter MRN, Davies BM. Lived experience-centred word clouds may improve research uncertainty gathering in priority setting partnerships. BMC Med Res Methodol 2023; 23:100. [PMID: 37087419 PMCID: PMC10122197 DOI: 10.1186/s12874-023-01897-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 03/20/2023] [Indexed: 04/24/2023] Open
Abstract
INTRODUCTION AO Spine RECODE-DCM was a multi-stakeholder priority setting partnership (PSP) to define the top ten research priorities for degenerative cervical myelopathy (DCM). Priorities were generated and iteratively refined using a series of surveys administered to surgeons, other healthcare professionals (oHCP) and people with DCM (PwDCM). The aim of this work was to utilise word clouds to enable the perspectives of people with the condition to be heard earlier in the PSP process than is traditionally the case. The objective was to evaluate the added value of word clouds in the process of defining research uncertainties in National Institute for Health Research (NIHR) James Lind Alliance (JLA) Priority Setting Partnerships. METHODS Patient-generated word clouds were created for the four survey subsections of the AO Spine RECODE-DCM PSP: diagnosis, treatment, long-term management and other issues. These were then evaluated as a nested methodological study. Word-clouds were created and iteratively refined by an online support group of people with DCM, before being curated by the RECODE-DCM management committee and expert healthcare professional representatives. The final word clouds were embedded within the surveys administered at random to 50% of participants. DCM research uncertainties suggested by participants were compared pre- and post-word cloud presentation. RESULTS A total of 215 (50.9%) participants were randomised to the word cloud stream, including 118 (55%) spinal surgeons, 52 (24%) PwDCM and 45 (21%) oHCP. Participants submitted 434 additional uncertainties after word cloud review: word count was lower and more uniform across each survey subsections compared to pre-word cloud uncertainties. Twenty-three (32%) of the final 74 PSP summary questions did not have a post-word cloud contribution and no summary question was formed exclusively on post-word cloud uncertainties. There were differences in mapping of pre- and post-word cloud uncertainties to summary questions, with greater mapping of post-word cloud uncertainties to the number 1 research question priority: raising awareness. Five of the final summary questions were more likely to map to the research uncertainties suggested by participants after having reviewed the word clouds. CONCLUSIONS Word clouds may increase the perspective of underrepresented stakeholders in the research question gathering stage of priority setting partnerships. This may help steer the process towards research questions that are of highest priority for people with the condition.
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Affiliation(s)
- Oliver D Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Lance Burn
- 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
| | - Xiaoyu Yang
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Sybil R L Stacpoole
- Department of Clinical Neurosciences, North West Anglia NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Toto Gronlund
- James Lind Alliance, National Institute for Health Research, Southampton, UK
| | - Lindsay Tetreault
- Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
| | | | - Michelle L Starkey
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Iwan Sadler
- Myelopathy.Org, (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Ellen Sarewitz
- The Goffin Consultancy, Goffin Consultancy Ltd, Riding House, Stelling Minnis, Bossingham Road, Canterbury, CT4 6AZ, UK
| | - Delphine Houlton
- Myelopathy.Org, (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Julia Carter
- Myelopathy.Org, (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Paige Howard
- US Person with DCM Representative - CSU, Bakersfield, CA, USA
| | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D Guest
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, MD, USA
| | - Brian K Kwon
- Division of Spine Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Robert Grossman
- Division of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | - Emma K Smith
- School of General Practice, NHS Health Education East of England, London, UK
| | - Angus McNair
- Center for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Mark R N Kotter
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- Wellcome Trust & MRC Cambridge Stem Cell Institute, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
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Afshari FT, Slator N, Fayeye O, Ramakrishnan PK, Solanki GA. Spinal canal stenosis in children with achondroplasia: the role of augmentation laminoplasty-a 15-year single institution experience. Childs Nerv Syst 2023; 39:229-37. [PMID: 35654849 DOI: 10.1007/s00381-022-05566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Achondroplasia typically results in compressive spinal canal stenosis in one-third of children, but rare under the age of 15 years. Laminectomy is the mainstay of treatment but this leads to instability and progressive deformity requiring complex fixation. In order to reduce that risk, we developed a novel modified augmented laminoplasty that increases spinal canal diameter while preserving the posterior column stability. METHODS All laminoplasty cases for spinal compressive achondroplasia from 2006 to 2020 were included. Ten augmentation laminoplasty procedures were performed in 7 children with regular clinical and radiological post-operative follow-up. Kyphotic deformity and clinical outcomes (neurological and urological) were evaluated. RESULTS At presentation, clinical features included radiculopathy, neurogenic claudication or acute cauda equina compression with sphincter dysfunction. The average age at initial surgery was 11.2 (range 5-16) with a mean follow-up of 5 (range 2-8) years. All patients demonstrated improvement in neurogenic claudication symptoms after surgery; however, bladder dysfunction persisted in some children. In one child, cervical and lumbar augmentation laminoplasties were performed for concomitant disease. Augmentation laminoplasty effectively prevented deformity progression over time in all cases except one where a further revision laminoplasty with extension was required for screw loosening. Despite this, progressive symptomatic kyphotic deformity led to a 360° fixation. Minor complications included one dural breach (repaired intraoperatively) and one superficial wound infection. CONCLUSION Augmentation laminoplasty is a viable surgical option following laminectomy in achondroplasia patients as an alternative to surgical fixation. Fixation can be reserved for cases where there is progressive deformity and kyphosis.
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Yekzaman BR, Minchew HM, Alvarado A, Ohiorhenuan I. Phrenic Nerve Dysfunction Secondary to Cervical Neuroforaminal Stenosis: A Literature Review. World Neurosurg 2022; 167:74-77. [PMID: 36089276 DOI: 10.1016/j.wneu.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phrenic nerve dysfunction has been associated with cervical neuroforaminal stenosis in limited case reports and case-controlled studies. It is unclear if magnetic resonance imaging of the cervical spine should be included in the workup of patients with pulmonary dysfunction. A systematic review of the current literature was conducted on the topic to provide an outline of the body of knowledge and some guidance for neurosurgeons that receive these patient referrals. METHODS A systematic literature review was conducted through the PubMed database to identify articles related to phrenic nerve dysfunction secondary to cervical stenosis. RESULTS A total of 12 case reports were found. The median subject age was 64 years, 11 were male. Presenting symptoms included shortness of breath (n = 9), radiculopathy (n = 7), myelopathy (n = 5), reduced pulmonary function (n = 6), weakness (n = 4), and neck pain (n = 5). Ten of these patients underwent surgical intervention, all having improvements in their pulmonary and neurological symptoms at follow-up ranging from 10 days to 2 years. CONCLUSIONS Cervical stenosis, resulting in neuroforaminal stenosis, may be related to phrenic nerve dysfunction in select patients with idiopathic diaphragmatic paralysis or pulmonary dysfunction. Surgical decompression improves pulmonary and neurological symptoms.
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Affiliation(s)
- Bailey R Yekzaman
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
| | - Heather M Minchew
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Anthony Alvarado
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Ifije Ohiorhenuan
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
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Shu XY, Dai Z, Zhang S, Yang HX, Bi H. Endometrial squamous cell carcinoma originating from the cervix: A case report. World J Clin Cases 2022; 10:8782-8787. [PMID: 36157822 PMCID: PMC9453359 DOI: 10.12998/wjcc.v10.i24.8782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/12/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cervical squamous cell carcinoma (SCC) is the most common type of cervical carcinoma and is generally derived from a precancerous stage called cervical high-grade squamous intraepithelial lesion (HSIL). Usually, the cancer metastasizes through lymphatic or hematogenous dissemination, but rarely spreads upward into the uterus. Here, we report a case of cervical HSIL extending into the endometrium and finally progressing to SCC in the uterine cavity.
CASE SUMMARY A 57-year-old postmenopausal woman visited our department and requested a routine cervical check-up. Four years ago, she had undergone a cervical loop electrosurgical excision procedure because of HSIL found during the gynecological examination, and she had not been checked again since. This time, a relapse of the cervical HSIL was diagnosed along with uterine pyometra and endometrial polyps. After 2 wk of antibiotic treatment, a laparoscopic hysterectomy was performed, and the final pathological examination revealed that the cervical HSIL had spread directly upward into the uterine cavity, gradually developing into cervical SCC in the endometrium.
CONCLUSION Cervical HSIL/SCC can directly spread upward into the uterus with the most common symptoms of pyometra and cervical stenosis. More attention should be given to the early detection and prevention of this disease.
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Affiliation(s)
- Xin-Yu Shu
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Zhang Dai
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Shuang Zhang
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Hui-Xia Yang
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
| | - Hui Bi
- Department of Gynecology and Obstetrics, Peking University First Hospital, Beijing 100034, China
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10
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Naftchi AF, Vellek J, Stack J, Spirollari E, Vazquez S, Das A, Greisman JD, Stadlan Z, Tarawneh OH, Zeller S, Dominguez JF, Kinon MD, Gandhi CD, Kazim SF, Schmidt MH, Bowers CA. Frailty as a Superior Predictor of Dysphagia and Surgically Placed Feeding Tube Requirement After Anterior Cervical Discectomy and Fusion Relative to Age. Dysphagia 2022. [PMID: 35945302 DOI: 10.1007/s00455-022-10505-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/25/2022] [Indexed: 11/03/2022]
Abstract
Frailty is a measure of physiological reserve that has been demonstrated to be a discriminative predictor of worse outcomes across multiple surgical subspecialties. Anterior cervical discectomy and fusion (ACDF) is one of the most common neurosurgical procedures in the United States and has a high incidence of postoperative dysphagia. To determine the association between frailty and dysphagia after ACDF and compare the predictive value of frailty and age. 155,300 patients with cervical stenosis (CS) who received ACDF were selected from the 2016-2019 National Inpatient Sample (NIS) utilizing International Classification of Disease, tenth edition (ICD-10) codes. The 11-point modified frailty index (mFI-11) was used to stratify patients based on frailty: mFI-11 = 0 was robust, mFI-11 = 1 was prefrail, mFI-11 = 2 was frail, and mFI-11 = 3 + was characterized as severely frail. Demographics, complications, and outcomes were compared between frailty groups. A total of 155,300 patients undergoing ACDF for CS were identified, 33,475 (21.6%) of whom were frail. Dysphagia occurred in 11,065 (7.1%) of all patients, and its incidence was significantly higher for frail patients (OR 1.569, p < 0.001). Frailty was a risk factor for postoperative complications (OR 1.681, p < 0.001). Increasing frailty and undergoing multilevel ACDF were significant independent predictors of negative postoperative outcomes, including dysphagia, surgically placed feeding tube (SPFT), prolonged LOS, non-home discharge, inpatient death, and increased total charges (p < 0.001 for all). Increasing mFI-11 score has better prognostic value than patient age in predicting postoperative dysphagia and SPFT after ACDF.
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11
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Saleh I, Librianto D, Kamal AF, Ipang F, Widodo W, Aprilya D. Particular precautions and the role of intraoperative neuromonitoring in cervical cord injury in elder recreational cyclist: A case report. Int J Surg Case Rep 2022; 96:107285. [PMID: 35704987 PMCID: PMC9198316 DOI: 10.1016/j.ijscr.2022.107285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/04/2022] [Accepted: 06/05/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The trend in cycling nowadays affects all age groups. However, special precautions must be considered in the elderly group. Minor trauma to the cervical region can cause severe neurological deterioration, leading to fatality because of the pre-existing degenerative process. CASE PRESENTATION We present a case of a 61-year-old male recreational cyclist with acute onset of tetraplegia following a minor fall. The radiological result revealed a long-standing degenerative process. Unfortunately, the patient deceased due to the sequelae of the paralysis and cardiac event despite our prompt surgical decompression and the improvement shown on intraoperative neuromonitoring. CLINICAL DISCUSSION The degenerative process can aggravate cervical cord injury even in its mildest form of injury. In this study, immediate improvement was detected by the intraoperative neuromonitoring (IONM) - although the clinical improvement had not improved yet as the general condition is poor. CONCLUSION The elder cycling population is increasing. Safety measures and injury avoidance are advisable along with expert consultation before the exercise. In a pre-existing degenerative condition of the cervical, a special precaution is also needed during the exercise. If the surgery has been indicated, the use of intraoperative neuromonitoring is found to be useful to guide the decompression and potentially beneficial as a predictive value for the clinal outcome.
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Affiliation(s)
- Ifran Saleh
- Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Didik Librianto
- Orthopedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fachrisal Ipang
- Orthopedic and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia
| | - Wahyu Widodo
- Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Dina Aprilya
- Orthopedic and Traumatology, Siloam Agora Hospital, Jakarta, Indonesia,Corresponding author.
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12
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Zhu C, Deng X, Pan H, Zhang W. Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis. Acta Neurochir (Wien) 2022; 164:1529-33. [PMID: 35486201 DOI: 10.1007/s00701-022-05212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The unilateral biportal endoscopic (UBE) technique is less invasive and has a faster recovery time than open surgery. Compared with the uniportal technique, the biportal technique has a larger field of vision and a wider operation range. METHOD We attempted the posterior UBE approach for cervical stenosis at the C4-C6 levels. UBE decompression of C4-C6 with unilateral lateral mass screw fixation at the C4-C5 levels was performed under general anesthesia. CONCLUSIONS We successfully performed cord decompression at the C4-C6 levels using the UBE technique. This approach could be used as an alternative method to treat cervical stenosis with instability.
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13
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Mittal S, Ahuja K, Sudhakar PV, Ifthekar S, Yadav G, Sarkar B, Kandwal P. Simultaneous decompression of all stenotic regions versus decompression of only the most symptomatic region in patients with tandem spinal stenosis: a systematic review and meta-analysis. Eur Spine J 2022; 31:561-574. [PMID: 34988710 DOI: 10.1007/s00586-021-07078-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/15/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Selection of anatomic region of spine for decompression in patients with symptomatic tandem spinal stenosis (TSS) remains a challenge due to the confusing clinical presentation as well as uncertain evidence. A systematic review and meta-analysis of observational studies were conducted to compare the outcomes between simultaneous decompression of all stenotic regions (cervical and lumbar, Group 1) and decompression of only the most symptomatic stenotic region (cervical/lumbar, Group 2) in patients with TSS. METHODS A systematic review was conducted, and a comprehensive literature search with well-established inclusion and exclusion criteria with JOA score as an outcome measure was done on PubMed, Google Scholar, and EMBASE database (till January 2021). Observational studies reporting outcomes after simultaneous decompression or only the most symptomatic region were included. NIH quality assessment tool was used to check the quality of each study, and treatment effects were calculated using Dersimonian and Laird random effects model. RESULTS Ten studies were included in the analysis out of which all were retrospective observational studies (Level 4 evidence) except one (Level 3 evidence). Overall proportional meta-analysis showed no significant difference in change in JOA scores, operative time, blood loss, total and major complications between Group 1 and Group 2. However, minor complications were significantly increased on performing decompression of both regions simultaneously (p = 0.04). On performing subgroup analysis comparing cervical surgery cohort with lumbar surgery cohort, no difference was found in change in JOA score and requirement of second-stage surgery. CONCLUSION Decompression of the most symptomatic region alone irrespective of its location has equal clinical outcomes with less complication rate than simultaneous decompression in patients with TSS.
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Affiliation(s)
| | | | - P V Sudhakar
- AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India
| | - Syed Ifthekar
- AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India
| | | | | | - Pankaj Kandwal
- Department of Orthopaedics, AIIMS Rishikesh, Rishikesh, Uttarakhand, 249203, India.
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14
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Galambas AK, Krengel WF, Parker CE, Kolenko AM, Browd SR, White KK, Bauer JM. The pediatric "Spine at Risk" program: 9-year review of a novel safety screening tool. Spine Deform 2022; 10:327-334. [PMID: 34705253 DOI: 10.1007/s43390-021-00430-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/16/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We implemented an EMR-based "Spine at Risk" (SAR) alert program in 2011 to identify pediatric patients at risk for intraoperative spinal cord injury (SCI) and prompt an evaluation for peri-operative recommendations prior to anesthetic. SAR alerts were activated upon documentation of a qualifying ICD-9/10 diagnosis or manually entered by providers. We aimed to determine the frequency of recommended precautions for those auto-flagged by diagnosis versus by provider, the frequency of precautions, and whether the program prevented SCIs during non-spinal surgery. METHODS We performed a retrospective chart review of patients from 2011 to 19 with an SAR alert. We recorded how the chart was flagged, recommended precautions, and reviewed data for SCIs at our institution during non-spinal operations. RESULTS Of the 3453 patients with an SAR alert over the 9-year study period, 1963 were auto-flagged by diagnosis and 1490 by manual entry. Only 38.7% and 24.3% of the patients in these respective groups were assigned precaution recommendations, making the auto-flag 62.8% better than providers at identifying patients needing precautions. Cervical spine positioning precautions were needed most frequently (86.7% of diagnosis-flagged; 30.0% of provider-flagged), followed by intraoperative neuromonitoring (IONM) (25.2%; 6.1%), thoracolumbar positioning restrictions (16.1%; 7.9%), and fiberoptic intubation (13.9%; 5.7%). There were no SCIs in non-spinal procedures during the study. CONCLUSION EMR-based alerts requiring evaluation by a Neurosurgeon or Orthopaedic surgeon prior to anesthesia can prevent SCIs during non-spinal procedures. The majority of identified patients are not found to be at risk, and will not require special precautions. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Walter F Krengel
- Department of Orthopaedics and Sports Medicine, Department of Orthopaedic Surgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Cheryl E Parker
- Department of Orthopaedic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Ana Maria Kolenko
- Department of Orthopaedic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Samuel R Browd
- Department of Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Klane K White
- Department of Orthopaedics and Sports Medicine, Department of Orthopaedic Surgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Jennifer M Bauer
- Department of Orthopaedics and Sports Medicine, Department of Orthopaedic Surgery, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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15
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Junior MGP, Dos Santos NADSQ, Ribeiro RT, Landeiro JA, Pessoa BL. Hypoplasia of C1's posterior arch: Is there an ideal anatomical classification? Surg Neurol Int 2022; 12:623. [PMID: 34992939 PMCID: PMC8720474 DOI: 10.25259/sni_820_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Congenital anomalies of the atlas are rare and usually occur in conjunction with other congenital variants. They include a wide spectrum of anomalies ranging from clefts to hypoplasia or aplasia of its arches that may contribute to spinal cord compressive syndrome. Case Description: A 54-year-old male presented with the sudden onset of a severe quadriparesis and loss of proprioception after a minor fall. The magnetic resonance (MR) scan showed cord compression at the C1 level attributed to C1 arch hypoplasia. Two months following a decompressive C1 laminectomy without fusion, and the patient was symptom free. Conclusion: Posterior C1 arch hypoplasia is a rare anomaly that can contribute to cervical cord compression and myelopathy. The optimal surgical management may include, as in this case, a posterior decompression without fusion.
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Affiliation(s)
| | | | - Raphael Tavares Ribeiro
- Department of Neurosurgery, Antônio Pedro University Hospital, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil
| | - Jose Alberto Landeiro
- Department of Neurosurgery, Antônio Pedro University Hospital, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil
| | - Bruno Lima Pessoa
- Department of Neurosurgery, Antônio Pedro University Hospital, Federal Fluminense University, Niteroi, Rio de Janeiro, Brazil
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16
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Han JY, Wong WL, Chan JKY. Labor Complicated by Cervical Stenosis Following a Laser Cone Biopsy. J Med Cases 2021; 12:13-15. [PMID: 34434420 PMCID: PMC8383636 DOI: 10.14740/jmc3605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
A 34-year-old lady, with three previous spontaneous vaginal deliveries, presented in labor at 37 + 0 weeks’ gestation. Following the birth of her third child, she underwent a laser cone biopsy for cervical intraepithelial neoplasia (CIN) 3. Despite sustained regular contractions and augmentation with Syntocinon, progressive cervical dilatation beyond 1 cm failed to occur in this multiparous lady. A delayed diagnosis of cervical stenosis was made. She eventually underwent a cesarean section where her internal cervical os was found to be thin and fibrotic. This case describes an uncommon occurrence of cervical stenosis presenting in labor and seeks to increase awareness of this condition so as to allow preemptive counselling of similar patients, early recognition in a labor with poor progress and a swift, better-informed decision to deliver via an emergency cesarean section. We review the existing literature on cervical stenosis following cervical conization and analyze the various definitions available.
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Affiliation(s)
- Jonathan Y Han
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wai Loong Wong
- Department of Gynecological Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jerry K Y Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore, Singapore.,Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
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17
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Zarour CC, Zaki-Metias KM, Kaur M, Mian A, Olson EB, Seedial SM. Idiopathic pyometra in a postmenopausal patient. Clin Imaging 2021; 80:145-147. [PMID: 34329900 DOI: 10.1016/j.clinimag.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/24/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Pyometra is a rare gynecological condition most commonly seen in elderly, postmenopausal women. Malignancy should always be considered as the primary etiology until proven otherwise in the investigation of an intrauterine infection. Clinical signs and symptoms can be vague or nonexistent, and thorough investigation with ultrasound and cross-sectional imaging may be necessary to understand the extent of the disease and best course of treatment. We describe a case of idiopathic pyometra in a postmenopausal woman, as well as review the pathophysiology, investigation, and management of pyometra.
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Affiliation(s)
- Christopher C Zarour
- Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - Kaitlin M Zaki-Metias
- Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, United States.
| | - Mehrvaan Kaur
- Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, United States
| | - Arooj Mian
- Department of Family Medicine, Ascension Genesys Hospital, Grand Blanc Township, MI, United States
| | - Eda B Olson
- Ross University School of Medicine, Bridgetown, Barbados
| | - Stephen M Seedial
- Department of Radiology, St. Joseph Mercy Oakland Hospital, Pontiac, MI, United States; Huron Valley Radiology, Ypsilanti, MI, United States
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18
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Hsu WK. Transient Quadriparesis and Cervical Neuropraxia in Elite Athletes. Clin Sports Med 2021; 40:463-70. [PMID: 34051940 DOI: 10.1016/j.csm.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Elite athletes are often faced with difficult decisions when faced with a cervical spinal disorder. There are many aspects to consider such as the risk of further injury, short- and long-term effects on an athlete's life both during and after his/her career, and the options for treatment. Although there have been some recent contributions to this topic, the evidence-based literature is generally devoid of high-level clinical studies to help guide the decision-making process. This article reviews the pertinent available data/criteria and offer an algorithm for return-to-play considerations.
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19
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Chae H. Administration of oxytocin antagonist at the same time as using a Foley catheter with cotton swab before embryo transfer for cervical stenosis. BMC Womens Health 2021; 21:265. [PMID: 34217262 PMCID: PMC8254982 DOI: 10.1186/s12905-021-01409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
Background Embryo transfer without difficulty in a patient with cervical stenosis can be a great challenge for in vitro fertilization (IVF). We report a successful pregnancy following a frozen thawed embryo transfer after administration of an oxytocin antagonist at the same time as using a Foley catheter with cotton swab in a patient with refractory cervical stenosis. Case presentation A 40-year-old woman undergoing IVF. The patient’s previous embryo transfers were difficult. For every transfer, uterine manipulation was needed, force was required, and dilatation was necessary. A Foley catheter with a cotton swab was inserted into the cervical canal, atosiban was administered at the same time, and the Foley catheter was removed immediately before embryo transfer. A smooth transfer was performed without bleeding, force, uterine manipulation, or cervical dilator. The patient became pregnant and delivered by cesarean section at term. Conclusion This method is effective in performing atraumatic embryo transfer in patients with cervical stenosis.
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Affiliation(s)
- Heesuk Chae
- Department of Obstetrics and Gynecology, Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University, 20, Geonji-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 561-712, South Korea.
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20
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Davies BM, Mowforth OD, Khan DZ, Yang X, Stacpoole SRL, Hazenbiller O, Gronlund T, Tetreault L, Kalsi-Ryan S, Starkey ML, Sadler I, Sarewitz E, Houlton D, Carter J, Howard E, Rahimi-Movaghar V, Guest JD, Aarabi B, Kwon BK, Kurpad SN, Harrop J, Wilson JR, Grossman R, Smith EK, McNair AGK, Fehlings MG, Kotter MRN. The development of lived experience-centered word clouds to support research uncertainty gathering in degenerative cervical myelopathy: results from an engagement process and protocol for their evaluation, via a nested randomized controlled trial. Trials 2021; 22:415. [PMID: 34172080 PMCID: PMC8235822 DOI: 10.1186/s13063-021-05349-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/01/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES AO Spine REsearch objectives and Common Data Elements for Degenerative Cervical Myelopathy [RECODE-DCM] is a multi-stakeholder consensus process aiming to promote research efficiency in DCM. It aims to establish the top 10 research uncertainties, through a James Lind Alliance Priority Setting Partnership [PSP]. Through a consensus process, research questions are generated and ranked. The inclusion of people with cervical myelopathy [PwCM] is central to the process. We hypothesized that presenting PwCM experience through word cloud generation would stimulate other key stakeholders to generate research questions better aligned with PwCM needs. This protocol outlines our plans to evaluate this as a nested methodological study within our PSP. METHODS An online poll asked PwCM to submit and vote on words associated with aspects of DCM. After review, a refined word list was re-polled for voting and word submission. Word clouds were generated and an implementation plan for AO Spine RECODE-DCM PSP surveys was subsequently developed. RESULTS Seventy-nine terms were submitted after the first poll. Eighty-seven refined words were then re-polled (which added a further 39 words). Four word clouds were generated under the categories of diagnosis, management, long-term effects, and other. A 1:1 block randomization protocol to assess word cloud impact on the number and relevance of PSP research questions was generated. CONCLUSIONS We have shown it is feasible to work with PwCM to generate a tool for the AO Spine RECODE-DCM nested methodological study. Once the survey stage is completed, we will be able to evaluate the impact of the word clouds. Further research will be needed to assess the value of any impact in terms of stimulating a more creative research agenda.
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Affiliation(s)
- Benjamin M Davies
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Oliver D Mowforth
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Danyal Z Khan
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Xiaoyu Yang
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Sybil R L Stacpoole
- Department of Clinical Neuroscience, Peterborough Hospital, North West Anglia NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | | | - Toto Gronlund
- James Lind Alliance, National Institute for Health Research, Southampton, UK
| | - Lindsay Tetreault
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sukhvinder Kalsi-Ryan
- Toronto Rehabilitation Institute-LC, University Health Network, Toronto, Ontario, Canada
| | - Michelle L Starkey
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK
| | - Iwan Sadler
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Ellen Sarewitz
- The Goffin Consultancy, Goffin Consultancy Ltd, Riding House, Bossingham Road, Stelling Minnis, Canterbury, CT4 6AZ, UK
| | - Delphine Houlton
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | - Julia Carter
- Myelopathy.org (Registered Charity England and Wales, No 1178673), Cambridge, UK
| | | | - Vafa Rahimi-Movaghar
- Academic Department of Neurological Surgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - James D Guest
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, MD, USA
| | - Brian K Kwon
- Division of Spine Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shekar N Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Jefferson R Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robert Grossman
- Division of Neurosurgery, Houston Methodist Hospital, Houston, TX, USA
| | - Emma K Smith
- School of General Practice, NHS Health Education East of England, Cambridge, UK
| | - Angus G K McNair
- Center for Surgical Research, Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mark R N Kotter
- Academic Neurosurgery Unit & Anne McLaren Laboratory of Regenerative Medicine, Department of Clinical Neurosurgery, University of Cambridge, Cambridge, UK. .,Wellcome Trust & MRC Cambridge Stem Cell Institute, Cambridge, UK.
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21
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Dowlati E, Voyadzis JM. Commentary: Asymptomatic Spinal Cord Compression: Is Surgery Necessary to Return to Play. Neurosurgery 2021; 88:E381-E382. [PMID: 33588437 DOI: 10.1093/neuros/nyab046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Jean-Marc Voyadzis
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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22
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Abstract
This article reviews the historical origins of central cord syndrome (CCS), the mechanism of injury, pathophysiology, and clinical implications. CCS is the most common form of incomplete spinal cord injury. CCS involves a spectrum of neurologic deficits preferentially affecting the hands and arms. Evidence suggests that in the twenty-first century CCS has become the most common form of spinal cord injury overall. In an era of big data and the need to standardize this particular diagnosis to unite outcome data, we propose redefining CCS as any adult cervical spinal cord injury in the absence of fracture/dislocation.
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Affiliation(s)
- Mauricio J Avila
- Department of Neurosurgery, University of Arizona, Banner University Medical Center, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA
| | - R John Hurlbert
- Department of Neurosurgery, University of Arizona, Banner University Medical Center, PO Box 245070, 1501 North Campbell Avenue, Room 4303, Tucson, AZ 85724-5070, USA.
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Lopez WY, Goh BC, Upadhyaya S, Ziino C, Georgakas PJ, Gupta A, Tobert DG, Fogel HA, Cha TD, Schwab JH, Bono CM, Hershman SH. Laminoplasty-an underutilized procedure for cervical spondylotic myelopathy. Spine J 2021; 21:571-577. [PMID: 33152508 DOI: 10.1016/j.spinee.2020.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/09/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTENT Cervical laminoplasty (LP) and laminectomy and fusion (LF) are commonly used surgical techniques for cervical spondylotic myelopathy (CSM). Several recent studies have demonstrated superior perioperative metrics and decreased overall costs with LP, yet LF is performed far more often in the United States. PURPOSE To determine the percentage of patients with CSM who are radiographically candidates for LP. STUDY DESIGN Retrospective comparative cohort study. PATIENT SAMPLE Patients >18 years old who underwent LF or LP for CSM at 2 large academic institutions from 2017 to 2019. OUTCOME MEASURES Candidacy for LP based on radiographic criteria. METHODS Radiographs were assessed by 2 spine surgeons not involved in the care of the patients to determine the C2-C7 Cobb angle and the presence and extent of cervical instability. Patients with kyphosis >13°, > 3.5 mm of listhesis on static imaging, or > 2.5 mm of motion on flexion-extension or standing-supine films were not considered candidates for LP. Intraclass coefficient (ICC) was calculated to assess the interobserver reliability of angular measurements and the presence of instability. The percentage of patients for whom LP was contraindicated was calculated. RESULTS One hundred eight patients underwent LF while 142 underwent LP. Of the 108 patients who underwent LF, 79.6% were radiographically deemed candidates for LP, as were all 142 patients who underwent LP. The ICC for C2-C7 alignment was 0.90; there was 97% agreement with respect to the presence of instability. CONCLUSIONS In 250 patients with CSM, 228 (91.2%) were radiographically candidates for LP. These data suggest that LP may be an underutilized procedure for the treatment for CSM.
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Affiliation(s)
- Wylie Y Lopez
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian C Goh
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shivam Upadhyaya
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chason Ziino
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter J Georgakas
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anmol Gupta
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel G Tobert
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Harold A Fogel
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas D Cha
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher M Bono
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stuart H Hershman
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Motwani G, Dhawale A, Shah A, Nene A. Cervical myelopathy in a child with Sprengel shoulder and Klippel-Feil syndrome. Spine Deform 2021; 9:303-309. [PMID: 32749619 DOI: 10.1007/s43390-020-00178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Sprengel shoulder, Klippel-Feil syndrome and congenital scoliosis are associated conditions. Cervical myelopathy in a child due to a concomitant omovertebral bar causing posterior cord compression and a hypermobile cervical disc protrusion adjacent to fused cervical segments causing anterior compression at the same level is very rare. We report the presentation, findings, surgical management and results of treatment in such a child. METHODS A 9-year-old girl with Sprengel shoulder presented with cervical myelopathy (Frankel D). Imaging revealed a bony omovertebral bar connected to the left scapula compressing the spinal cord posteriorly through a lamina defect at C5 resulting in significant cervical stenosis. A hypermobile disc protrusion adjacent to congenitally fused segments resulted in anterior compression at the same level. She was treated surgically with cervical laminectomy and instrumented fusion, excision of the omovertebral bar and modified Woodward procedure for the left Sprengel shoulder. RESULTS At 2 year follow-up, she had improved neurologically (Frankel E) and there was improved shoulder symmetry and abduction. MRI showed resolution of cervical stenosis. Although there was no significant progression of congenital scoliosis, it will need to be monitored. CONCLUSIONS Cervical myelopathy due to an omovertebral bar and cervical disc protrusion in a child with Klippel-Feil syndrome and Sprengel shoulder is a rare presentation and can be treated with a single posterior approach addressing both pathologies.
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Affiliation(s)
- Girish Motwani
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, A. Dondhe Marg, Parel, Mumbai, 400012, India
| | - Arjun Dhawale
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, A. Dondhe Marg, Parel, Mumbai, 400012, India. .,Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Mumbai, 400004, India.
| | - Avi Shah
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, A. Dondhe Marg, Parel, Mumbai, 400012, India
| | - Abhay Nene
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, A. Dondhe Marg, Parel, Mumbai, 400012, India
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Kumagai G, Wada K, Tanaka S, Asari T, Ishibashi Y. Cervical arteriosclerosis is associated with preoperative clinical symptoms in patients with cervical spondylotic myelopathy. Eur Spine J 2021; 30:547-53. [PMID: 33165730 DOI: 10.1007/s00586-020-06649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aims to clarify the association between cervical spondylotic myelopathy (CSM) and cervical arteriosclerosis using ultrasonography that comprehensively includes spinal cord stenosis. METHODS Eighty-two consecutive patients aged over 60 years who underwent spine surgery were divided into those with CSM (n = 31; CSM group) and those with lumbar spinal stenosis without cervical myelopathy (n = 51; LSS group). Maximum spinal cord compression (MSCC) was evaluated for cervical stenosis severity using magnetic resonance (MR) images. The intima-media thickness (IMT) of the common carotid artery (CCA) and pulsatility index (PI) of the bilateral internal carotid artery (ICA) and vertebral artery (VA) were evaluated for cervical arteriosclerosis using pulsed-wave Doppler ultrasonography. Symptom severity was evaluated using the Japanese Orthopaedic Association (JOA) score. Spearman's correlation coefficient was used to determine the relationship between the JOA score and MSCC or IMT and PI in each group. Stepwise multiple linear regression analyses were conducted with the JOA score as a dependent variable and age, sex, body mass index, cervical arteriosclerosis assessment, and MSCC as independent variables. RESULTS Bilateral IMT and left-side ICA-PI were significantly negatively correlated with JOA scores in the CSM group (Right-CCA-IMT: R = - 0.412, Left-IMT: R = - 0.549, Left-ICA -PI: R = - 0.205, P < 0.05), but not in the LSS group. Multiple linear regression analyses showed that CCA-IMT was the strongest independent factor associated with the preoperative JOA score. CONCLUSIONS Cervical arteriosclerosis was associated with preoperative clinical symptoms in CSM patients.
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Kleimeyer JP, Koltsov JCB, Smuck MW, Wood KB, Cheng I, Hu SS. Cervical epidural steroid injections: incidence and determinants of subsequent surgery. Spine J 2020; 20:1729-1736. [PMID: 32565316 DOI: 10.1016/j.spinee.2020.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cervical epidural steroid injections (CESIs) are sometimes used in the management of cervical radicular pain in order to delay or avoid surgery. However, the rate and determinants of surgery following CESIs remain uncertain. PURPOSE This study sought to determine: (1) the proportion of patients having surgery following CESI, and (2) the timing of and factors associated with subsequent surgery. STUDY DESIGN Retrospective analysis of a large, national administrative claims database. PATIENT SAMPLE The study included 192,777 CESI patients (age 50.9±11.3 years, 55.2% female) who underwent CESI for imaging-based diagnoses of cervical disc herniation or stenosis, a clinical diagnosis of radiculopathy, or a combination thereof. OUTCOME MEASURES The primary outcome was the time from index CESI to surgery. METHODS Inclusion criteria were CESI for cervical disc herniation, stenosis, or radiculopathy, age ≥18, and active enrollment for 1 year before CESI to screen for exclusions. Patients were followed until they underwent cervical surgery, or their enrollment lapsed. Rates of surgery were assessed with Kaplan-Meier survival curves and 99% confidence intervals. Factors associated with subsequent surgery were assessed with multivariable Cox proportional hazard models. RESULTS Within 6 months of CESI, 11.2% of patients underwent surgery, increasing to 14.5% by 1 year and 22.3% by 5 years. Male patients and those aged 35 to 54 had an increased likelihood of subsequent surgery. Patients with radiculopathy were less likely to undergo surgery following CESI than those with stenosis or herniation, while patients with multiple diagnoses were more likely. Patients with comorbidities including CHF, other cardiac comorbidities or chronic pain were less likely to undergo surgery, as were patients in the northeast US region. Some 33.5% of patients underwent >1 CESI, with 84.6% of these occurring within 1 year. Additional injections were associated with reduced rates of subsequent surgery. CONCLUSIONS Following CESI, over one in five patients underwent surgery within 5 years. Multiple patient-specific risk factors for subsequent surgery were identified, and patients undergoing repeated injections were at lower risk. Determining which patients may progress to surgery can be used to improve resource utilization and to inform shared decision-making.
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Affiliation(s)
- John P Kleimeyer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA
| | - Jayme C B Koltsov
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA
| | - Matthew W Smuck
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA
| | - Kirkham B Wood
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA
| | - Ivan Cheng
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA
| | - Serena S Hu
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street MC 6342, Redwood City, CA 94063, USA.
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Davison MA, Lilly DT, Eldridge CM, Singh R, Bagley C, Adogwa O. Regional differences in prolonged non-operative therapy utilization prior to primary ACDF surgery. J Clin Neurosci 2020; 80:143-151. [PMID: 33099337 DOI: 10.1016/j.jocn.2020.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022]
Abstract
There is a paucity of data characterizing regional variations in the utilization and costs of conservative management in patients suffering from cervical stenosis prior to anterior cervical discectomy and fusion (ACDF) surgery. An understating of these regional trends becomes critical as outcomes-based reimbursement strategies become standard. The objective of this investigation was to evaluate for regional differences in the utilization and overall costs of maximal non-operative therapy (MNT) prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing a ≤3-level index ACDF procedure between 2007 and 2016 were accessed from a large insurance database. Geographic regions (Midwest, Northeast, South, and West) reflected U.S. Census Bureau definitions. MNT utilization within 2-years prior to ACDF surgery was analyzed. An index ACDF surgery was performed in 15,825 patients. Patient regional breakdown was as follows: South (67.6% of patients), Midwest (21.8% of patients), West (8.9% of patients), Northeast (1.6% of patients). Regional variations were identified in the number of patients utilizing NSAIDs (p < 0.001), opioids (p < 0.001), muscle relaxants (p < 0.001), cervical epidural steroid injections (p = 0.001), physical therapy/occupational therapy treatments (p < 0.001), and chiropractor visits (p < 0.001). The West (64.5%) and South (63.5%) had the greatest proportion of patients utilizing narcotics. When normalized by the number of opioid using-patients however, the Northeast (691.4 pills/patient) and South (674.4 pills/patient) billed for the most opioid pills. The total direct cost associated with all MNT prior to index ACDF was $17,255,828. The Midwest ($1,277.72 per patient) and South ($1,047.86 per patient) had the greatest average dollars billed.
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Affiliation(s)
- Mark A Davison
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Cody M Eldridge
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ravinderjit Singh
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States.
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Davison MA, Lilly DT, Eldridge CM, Singh R, Bagley C, Adogwa O. A comparison of prolonged nonoperative management strategies in cervical stenosis patients: Successes versus failures. J Clin Neurosci 2020; 80:63-71. [PMID: 33099369 DOI: 10.1016/j.jocn.2020.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/20/2020] [Accepted: 07/19/2020] [Indexed: 12/25/2022]
Abstract
A paucity of evidence exists regarding the optimal composition of conservative therapies to best treat patients diagnosed with cervical stenosis prior to consideration of surgery. The purpose of this study was to compare the nonoperative therapy utilization strategies in cervical stenosis patients successfully managed with conservative treatments versus those that failed medical management and opted for an anterior cervical discectomy and fusion (ACDF) surgery. Medical records from adult patients with a diagnosis of cervical stenosis from 2007 to 2017 were collected retrospectively from a large insurance database. Patients were divided into two cohorts: patients treated successfully with nonoperative therapies and patients that failed conservative management and opted for ACDF surgery. Nonoperative therapies utilized by the two cohorts were collected over a 2-year surveillance window. A total of 90,037 adult patients with cervical stenosis comprised the base population. There were 83,384 patients (92.6%) successfully treated with nonoperative therapies alone, while 6,653 patients (7.4%) ultimately failed conservative management and received an ACDF. Failure rates of non-operative therapies were higher in smokers (11.2%), patients receiving cervical epidural steroid injections (11.2%), and male patients (8.1%). A greater percentage of patients who failed conservative management utilized opioid medications (p < 0.001), muscle relaxants (p < 0.001), and CESIs (p < 0.001). The costs of treating patients that failed conservative management was double the amount of the successfully treated group (failed cohort: $1,215.73 per patient; successful cohort: $659.58 per patient). A logistic regression analysis demonstrated that male patients, smokers, opioid utilization, and obesity were independent predictors of conservative treatment failure.
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Affiliation(s)
- Mark A Davison
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel T Lilly
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Cody M Eldridge
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ravinderjit Singh
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Kwasnicki A, McGuire LS, Lichtenbaum R. Neurologic Clinical Manifestations of Fahr Syndrome and Hypoparathyroidism. World Neurosurg 2020; 144:115-116. [PMID: 32745648 DOI: 10.1016/j.wneu.2020.07.160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/22/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
A 41-year-old female with a history of chronic hypoparathyroidism with Fahr syndrome presented with complaints of weakness and muscle spasticity. Brain imaging demonstrated diffuse intracranial calcifications. In addition, cervical spine imaging revealed extensive calcification along the anterior and posterior cervical vertebral bodies causing multilevel stenosis and cord compression. The patient underwent a multilevel posterior cervical decompression and fusion. Postoperatively, the patient had noted improvement in her upper and lower extremity strength and spasticity. This illustrative case demonstrates rare clinical and radiographic neurologic sequelae of long-standing hypoparathyroidism.
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Affiliation(s)
- Amanda Kwasnicki
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Laura Stone McGuire
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Roger Lichtenbaum
- Department of Neurological Surgery, University of Illinois at Chicago, Chicago, Illinois, USA; Department of Neurological Surgery, Saint Joseph Hospital, Chicago, Illinois, USA
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30
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Naylor RM, Lenartowicz KA, Graff-Radford J, Jones DT, Cutsforth-Gregory JK, Graff-Radford NR, Elder BD. High prevalence of cervical myelopathy in patients with idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2020; 197:106099. [PMID: 32702575 DOI: 10.1016/j.clineuro.2020.106099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. Some patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical myelopathy in patients with iNPH. METHODS A consecutive series of patients undergoing shunt placement for iNPH were screened for cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS Fifty-two patients shunted for treatment of iNPH were included for analysis. 58 % were male with a mean age of 75.2 years (SD 7.3 years). All patients presented with gait disturbances. 39/52 (75 %) had cervical stenosis, and 9/52 (17.3 %) had significant (grade 2-3) cervical stenosis with myelopathy and were subsequently treated with surgical decompression. There was an association between increasing grade of stenosis and disproportionately enlarged subarachnoid space hydrocephalus (DESH). All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSIONS Clinically significant cervical myelopathy was prevalent in patients with iNPH and was associated with increased rate of DESH, a finding that requires validation in a larger cohort. Based on these results, cervical imaging could be considered preoperatively in patients with iNPH, particularly when upper motor neuron findings are identified. Additionally, concomitant cervical stenosis should be ruled out in patients whose gait does not improve after shunt placement.
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Affiliation(s)
- Ryan M Naylor
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States
| | | | | | - David T Jones
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Benjamin D Elder
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, United States; Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, United States; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, United States.
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Gratch D, Do D, Khankhanian P, Schindler M, Schmitt JE, Berger JR. Impact of cervical stenosis on multiple sclerosis lesion distribution in the spinal cord. Mult Scler Relat Disord 2020; 45:102415. [PMID: 32717683 DOI: 10.1016/j.msard.2020.102415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether demyelinating lesions attributable to multiple sclerosis (MS) occur more commonly in regions of pre-existing cervical stenosis (CS). DESIGN/METHODS One hundred comorbid MS/CS patients and 100 MS-only controls were identified via ICD codes and radiology reports from a retrospective chart review of the records of the University of Pennsylvania Hospital System (UPHS) from January 1st, 2009 to December 31st, 2018. For each patient, axial and sagittal T2 sequences of cervical MRI scans were examined. The cervical cord was split into 7 equal segments comprising the disc space and half of each adjacent vertebral body. Each segment was assessed for the presence of MS lesions and grade 2 CS or higher by previously published criteria. Lesions which were concerning for spondylotic-related signal change based on imaging characteristics were excluded (n=6, 3.2%). Clinical data was extracted from the electronic medical record. RESULTS Average age at the time of MRI was 57.0 +/- 10.5 years and average time with MS diagnosis was 15.3 +/- 9.2 years. The majority of patients had a diagnosis of relapse-remitting MS (81.0%) and the F:M ratio was 3.5. Eighty-five percent of patients were on treatment at the time of MRI, most often glatiramer acetate (35.0%). Spinal segments with at least grade 2 stenosis were significantly associated with the presence of an MS lesion in the same segment (χ2 = 19.0, p < 0.001, OR = 2.6, 95% CI 1.8-3.7). CONCLUSIONS Our data suggest there is a significant association between segments of spinal cord with at least moderate CS and segments with MS lesions. Further analysis is required to assess if cervical stenosis is a causative or aggravating factor in multiple sclerosis.
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Di Spiezio Sardo A, Giampaolino P, Manzi A, De Angelis MC, Zizolfi B, Alonso L, Carugno J. The Invisible External Cervical Os. Tips and Tricks to Overcome this Challenge during In-Office Hysteroscopy. J Minim Invasive Gynecol 2020; 28:172-173. [PMID: 32526381 DOI: 10.1016/j.jmig.2020.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Hysteroscopy is considered the gold standard technique for the diagnosis and management of intrauterine pathology allowing to "see and treat" patients in 1 session if desired [1-3]. Pain and the inability to enter the uterine cavity are the most common limitations of hysteroscopy, especially when performed in an office setting [4-7]. Cervical stenosis is a common hysteroscopic finding frequently encountered in postmenopausal women, especially in patients with a history of cervical procedures such as cone biopsy [8]. It represents a challenge even for the most expert hysteroscopist. Overcoming the stenosis of the external cervical os is technically more demanding than facing the obliteration of the internal os. The aim of this video article is to illustrate the use of simple techniques that allow the hysteroscopist to safely identify the location of the external cervical os and to overcome the difficulties in entering the uterine cavity during in-office hysteroscopy in patients with severe cervical stenosis including those with complete obliteration of the external cervical os. These techniques are easy to adopt and can be used in different clinical situations in which the hysteroscopic evaluation of the uterine cavity is needed in women with severe cervical stenosis. DESIGN A series of videos of challenging cases with severe cervical stenosis with complete obliteration of the external cervical os are presented that demonstrate maneuvers to properly identify and enter the cervical canal, unfolding key aspects of the procedure. Tips and tricks to facilitate the adoption of these useful maneuvers into clinical practice are highlighted. SETTING In-office diagnostic hysteroscopy was performed using a 5-mm rigid continuous flow operative hysteroscope. Patients were placed in a dorsal lithotomy position. The vaginoscopy "no touch" technique was used [9]. No anesthesia or sedation was administered to any of the patients. Normal saline was used as distention media. INTERVENTIONS Taking advantage of the magnification provided by the hysteroscope, the location of the external cervical os was determined. In cases in which the external cervical os was not clearly recognized, the cervix was gently probed with the use of the uterine palpator, grasper, or scissors (Fig. 1). Recognition of the landmarks of the cervical canal provides reassurance of the adequate identification of the external cervical os and facilitates the use of the correct plane of dissection that leads into the uterine cavity (Fig. 2). Additional maneuvers that are useful to navigate the endocervical canal to overcome stenosis of the internal cervical os are also illustrated. CONCLUSION The combination of a delicate technique and operator experience aids in overcoming the challenge of cervical stenosis in an office setting. Adopting the presented tips and tricks to enter the uterine cavity in the presence of severe cervical stenosis will reduce the rate of failed hysteroscopic procedures, decreasing the need to take patients to the operating room and the use of general anesthesia.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Pierluigi Giampaolino
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Alfonso Manzi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Maria Chiara De Angelis
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Brunella Zizolfi
- Department of Public Health, University of Naples Federico II, Naples, Italy (Drs. Sardo, Giampaolino, Manzi, De Angelis, and Zizolfi)
| | - Luis Alonso
- Department of Gynecologic Endoscopy, Centro Gutenberg, Malaga, Spain (Dr. Alonso)
| | - Jose Carugno
- Department of Obstetrics, Gynecology and Reproductive Sciences, Miller School of Medicine, University of Miami, Miami, Florida (Dr. Carugno).
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Davison MA, Lilly DT, Moreno J, Bagley C, Adogwa O. Gender differences in use of prolonged non-operative therapies prior to index ACDF surgery. J Clin Neurosci 2020; 78:228-235. [PMID: 32507293 DOI: 10.1016/j.jocn.2020.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Prior to anterior cervical discectomy and fusion (ACDF) surgery, patients suffering from cervical stenosis traditionally trial non-operative treatments for pain management. There is a paucity of data evaluating gender disparities in the prolonged utilization of conservative therapy prior to ACDF surgery. Therefore, the purpose of this study was to assess for gender-based differences in the utilization and cost of maximal non-operative therapy (MNT) for cervical stenosis prior to ACDF surgery. Medical records from patients with symptomatic cervical stenosis undergoing 1, 2, or 3-level index ACDF procedures between 2007 and 2016 were gathered from an insurance database consisting of 20.9 million covered lives. The utilization of MNTs within 5 years prior to index ACDF surgery was assessed. A total of 2254 patients (females: 53.1%) underwent an index ACDF surgery. There were a significantly greater percentage of female patients that utilized NSAIDs (p < 0.0001), opioids (p = 0.0019), muscle relaxants (p < 0.0001), cervical epidural steroid injections (p = 0.0428), and physical therapy/occupational therapy treatments (p < 0.0001). The total direct cost associated with all MNT prior to index ACDF was $4,833,384. On average, $2028.01 was spent per male patient while $2247.29 was spent per female patient. When normalized by number of pills billed per patient utilizing therapy, female patients utilized more NSAIDs (males: 591.8 pills, females: 669.3 pills), opioids (male: 1342.0 pills, female: 1650.1 pills), and muscle relaxants (males: 823.7 pills, females: 1211.1 pills). The results suggest that there may be gender differences in the utilization of non-operative therapies for symptomatic cervical stenosis prior to ACDF surgery.
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Affiliation(s)
- Mark A Davison
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel T Lilly
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Jessica Moreno
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Carlos Bagley
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Owoicho Adogwa
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, United States
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Musella A, Santangelo G, Vertechy L, Di Pinto A, Sassu CM, Fischetti M, Di Donato V, Perniola G, Palaia I, Benedetti Panici P. Post-conization cervical stenosis treated with silicone catheter in microinvasive cervical cancer patient: A case report. Int J Surg Case Rep 2020; 67:95-7. [PMID: 32058308 DOI: 10.1016/j.ijscr.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 11/21/2022] Open
Abstract
Cervical Cancer patient experienced a Cervical stenosis after conization. Cervical stenosis is one of the most frequent complication of conization. The use of a silicon urethral catheter into the cervical canal is a resolutive option.
Introduction Cervical stenosis can represent a hard complication to treat after conization for microinvasive cervical cancer. Presentation of case A young woman with cervical stenosis post-trachelectomy for a microinvasive cervical cancer came to our Department. We introduced a silicone catheter of 18 French in cervical canal. The catheter was removed after 20 days. The procedure was resolutive. Discussion Cervical stenosis is one of the most frequent complication of conization. Among the different described techniques proposed in literature, we would here report the successful use of a silicon urethral catheter into the cervical canal. Conclusion This method can be an easy and cheap procedure to take in consideration.
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Genovese F, D'Urso G, Di Guardo F, Insalaco G, Tuscano A, Ciotta L, Carbonaro A, Leanza V, Palumbo M. Failed diagnostic hysteroscopy: Analysis of 62 cases. Eur J Obstet Gynecol Reprod Biol 2019; 245:193-197. [PMID: 31864715 DOI: 10.1016/j.ejogrb.2019.10.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/30/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of the presented study is to improve the office hysteroscopy success rate identifying some of the factors associated to an unsuccessful procedure. Moreover it would highlight the importance of an adequate patients follow up after office hysteroscopy failure enlightening the uterine pathologies missed at the first attempt. STUDYDESIGN This is a retrospective observational study. The Authors reviewed the medical records related to 516 office hysteroscopies performed from January 2016 to November 2018, extrapolating the data from the failed hysteroscopies occurred during this period. After the procedure failure all patients were offered to repeat the hysteroscopy under regional anesthesia in order to identify and treat uterine pathologies. Those patients, who declined to repeat the procedure, received an appropriate follow up. Each failure case is correlated with patient clinical characteristics, indications to hysteroscopy, risk factors presence, hysteroscopy patient compliance, pathology result and patient follow up. RESULTS The presented study shows an office hysteroscopy failure rate of about 12 %. Severe pain due to cervical stenosis, previous uterine surgery, postmenopausal status and marked uterine ventrifixation/retroflexion, represent the main reason why the procedure was not completed in an office setting. The uterine cavity was subsequently examined in only 26 (42 %) out of 62 patients who reported hysteroscopy failure, mostly repeating the procedure under regional anesthesia (24 cases) or performing vaginal hysterectomy for associated benign gynaecological pathology (2 cases). Endometrial malign pathology (endometrioid carcinoma) was diagnosed in 2 cases of them (7.7 %). Moreover the endometrial cavity remained so far unexplored in 36 (58 %) out of 62 patients, due to the patient refuse to repeat the hysteroscopy under anesthesia. DISCUSSION AND CONCLUSION Results of the present study suggest that office hysteroscopy should be sussessful at the first attempt due to the patients' refuse, in majority of cases, to repeat the procedure after a failure. To not repeat the hysteroscopy may lead to lose or delay important diagnosis, such as that of endometrial cancer. In this context, to counsel all patients prior the procedure may singnificanly help to identify those who may benefit of pharmacological cervical softening, local anesthetic injection or small caliber hysteroscopes usage, increasing the procedure success rate.
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Affiliation(s)
- Fortunato Genovese
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Gisella D'Urso
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Federica Di Guardo
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy.
| | - Giulio Insalaco
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Attlio Tuscano
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Lilliana Ciotta
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Antonio Carbonaro
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Vito Leanza
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
| | - Marco Palumbo
- Department of Medical Surgical Specialties, University of Catania, Via Tindaro 2, 95124, Catania, Italy
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Pennington Z, Alentado VJ, Lubelski D, Alvin MD, Levin JM, Benzel EC, Mroz TE. Quality of life changes after lumbar decompression in patients with tandem spinal stenosis. Clin Neurol Neurosurg 2019; 184:105455. [PMID: 31376775 DOI: 10.1016/j.clineuro.2019.105455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tandem spinal stenosis (TSS) is a degenerative spinal condition characterized by spinal canal narrowing at 2 or more distinct spinal levels. It is an aging-related condition that is likely to increase as the population ages, but which remains poorly described in the literature. Here we sought to determine the impact of primary lumbar decompression on quality-of-life (QOL) outcomes in patients with symptomatic TSS. PATIENTS AND METHODS We retrospectively reviewed 803 patients with clinical and radiographic evidence of TSS treated between 2008 and 2014 with a minimum 2-year follow-up. The records of patients with clinical and radiographic evidence of concurrent cervical and lumbar stenosis were reviewed. Prospectively gathered QOL data, including the Pain Disability Questionnaire (PDQ), Patient Health Questionnaire-9 (PHQ-9), EuroQOL-5 Dimensions (EQ-5D), and Visual Analogue Scale (VAS) for low back pain, were assessed at the 6-month, 1-year, and 2-year follow-ups. RESULTS Of 803 identified patients (mean age 66.2 years; 46.9% male), 19.6% underwent lumbar decompression only, 14.1% underwent cervical + lumbar decompression, and 66.4% underwent conservative management only. Baseline VAS scores were similar across all groups, but patients undergoing conservative management had better baseline QOL scores on all other measures. Both surgical cohorts experienced significant improvements in the VAS, PDQ, and EQ-5D at all time points; patients in the cervical + lumbar cohort also had significant improvement in the PHQ-9. Conservatively managed patients showed no significant improvement in QOL scores at any follow-up interval. CONCLUSION Lumbar decompression with or without cervical decompression improves low back pain and QOL outcomes in patients with TSS. The decision to prioritize lumbar decompression is therefore unlikely to adversely affect long-term quality-of-life improvements.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Vincent J Alentado
- Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew D Alvin
- Department of Diagnostic Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jay M Levin
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Edward C Benzel
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas E Mroz
- Cleveland Clinic Center for Spine Health, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; Department of Neurological Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Guo C, Zhang L, Kong Q, Wang Y, Yang J, Yan Y, Wu H, Peng Z. Full Endoscopic Key Hole Technique for Cervical Foraminal Stenosis: Is Mere Dorsal Decompression Enough? World Neurosurg 2019; 126:e16-26. [PMID: 30685369 DOI: 10.1016/j.wneu.2019.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study whether and when mere dorsal decompression is enough in the full endoscopic key hole technique for foraminal stenosis. METHODS We retrospectively reviewed a total of 22 patients with cervical foraminal stenosis who underwent full endoscopic key hole mere dorsal decompression in our institute from October 2016 to October 2017. RESULTS Preoperative neck disability index, neck visual analog scale score, and arm visual analog scale score were 25.8 ± 0.8, 4.9 ± 0.6, and 7.5 ± 0.5 in the group. Immediate postoperative scores were 6.9 ± 0.9, 1.3 ± 0.9, and 1.4 ± 0.5. Follow-up scores at 3 months (7.0 ± 0.9, 1.9 ± 0.6, and 2.7 ± 0.9), 6 months (7.3 ± 0.9, 2.1 ± 0.9, and 1.9 ± 0.5), and 12 months (7.6 ± 0.5, 2.5 ± 0.8, and 2.1 ± 0.7). The symptoms had improved significantly (P < 0.05). According to the Macnab criteria, 15 patients reported excellent results, 2 reported good results, and 2 reported fair results at the 12-month follow-up. CONCLUSIONS Stenosis is mainly caused by dorsal structures; mere dorsal decompression is enough. In both cases, the ventral and dorsal structures contributed to the stenosis. When there is no herniated soft fragment contributing to the stenosis, ventral decompression is not always necessary. If intraoperative exploration detects less tension formed by the ventral abnormal structures, mere dorsal decompression is enough to settle the symptoms.
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Cheung JPY, Cheung PWH, Chiu CK, Chan CYW, Kwan MK. Variations in Practice among Asia-Pacific Surgeons and Recommendations for Managing Cervical Myelopathy: The First Asia-Pacific Spine Society Collaborative Study. Asian Spine J 2018; 13:45-55. [PMID: 30326696 PMCID: PMC6365774 DOI: 10.31616/asj.2018.0135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN Surgeon survey. PURPOSE To study the various surgical practices of different surgeons in the Asia-Pacific region. OVERVIEW OF LITERATURE Given the diversity among Asia-Pacific surgeons, there is no clear consensus on the preferred management strategies for cervical myelopathy. In particular, the role of prophylactic decompression for silent cervical spinal stenosis is under constant debate and should be addressed. METHODS Surgeons from the Asia-Pacific Spine Society participated in an online questionnaire comprising 50 questions. Data on clinical diagnosis, investigations and outcome measures, approach to asymptomatic and silent cervical spinal stenosis, guidelines for surgical approach, and postoperative immobilization were recorded. All parameters were analyzed by the Mantel-Haenszel test. RESULTS A total of 79 surgeons from 16 countries participated. Most surgeons used gait disturbance (60.5%) and dyskinetic hand movement (46.1%) for diagnosis. Up to 5.2% of surgeons would operate on asymptomatic spinal stenosis, and 18.2% would operate on silent spinal stenosis. Among those who would not operate, most (57.1%) advised patients on avoidance behavior and up to 9.5% prescribed neck collars. For ossification of the posterior longitudinal ligament (OPLL), anterior removal was most commonly performed for one-level disease (p<0.001), whereas laminoplasty was most commonly performed for two- to four-level disease (p=0.036). More surgeons considered laminectomy and fusion for multilevel OPLL. Most surgeons generally preferred to use a rigid neck collar for 6 weeks postoperatively (p<0.001). CONCLUSIONS The pooled recommendations include prophylactic or early decompression surgery for patients with silent cervical spinal stenosis, particularly OPLL. Anterior decompression is primarily suggested for one- or two-level disease, whereas laminoplasty is preferred for multilevel disease.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, SAR, China
| | | | - Chee Kidd Chiu
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chris Yin Wei Chan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mun Keong Kwan
- Department of Orthopaedic Surgery, National Orthopaedic Centre of Excellence for Research and Learning, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Tuchman A, Tan LA, Shillingford JN, Li XJ, Riew KD. Dynamic changes in the reflex exam of patients with sub-axial cervical stenosis. J Clin Neurosci 2018; 60:84-87. [PMID: 30309800 DOI: 10.1016/j.jocn.2018.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/26/2018] [Indexed: 12/19/2022]
Abstract
Though dynamic changes in the physical exam of patients being evaluated for cervical spine pathology have been reported, there is limited information on the prevalence and clinical features associated with reflex changes in a population undergoing surgical evaluation for cervical spine pathology. Fifty-one patients with at least grade 1 cervical stenosis on MRI underwent initial surgical evaluation for cervical spine pathology. All patients received complete neurologic examinations including dynamic reflex testing in three positions (neck neutral, extended, and flexed) by 2 spine surgeons. The average age was 58.7 years (range, 34-80), with 28 (55%) patients being male. Stenosis at the symptomatic levels was grade 1 in 18 patients (35%), grade 2 in 11 (21%), and grade 3 in 22 (43%). Twenty-one patients (41%) had a dynamic change in reflex exam. The most common change in reflex exam was seen in the Hoffman's reflex with 14 patients (28%). Patients with grade 3 stenosis were more likely to have a static Hoffman's reflex (64%) compared with grade 1 (17%) and grade 2 (18%) (p < 0.05). Patients with grade 3 stenosis had a higher rate of either a static or dynamic Hoffman's reflex (82%) compared with grade 1 (44%) (p < 0.05), but there was no difference between grade 3 and grade 2 (64%) (Table 2). Dynamic changes in reflex exam are commonly seen in patients being evaluated for symptomatic cervical stenosis. The routine neurologic exam can be supplemented with dynamic reflex testing, especially in cases where clinical history or imaging is concerning for cervical myelopathy.
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Affiliation(s)
- Alexander Tuchman
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West - 022, New York, NY 10034, United States.
| | - Lee A Tan
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West - 022, New York, NY 10034, United States
| | - Jamal N Shillingford
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West - 022, New York, NY 10034, United States
| | - Xudong J Li
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West - 022, New York, NY 10034, United States
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital, New York-Presbyterian Healthcare System, 5141 Broadway, 3 Field West - 022, New York, NY 10034, United States
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Khachatryan T, Robinson JS. The possible impact of cervical stenosis on cephalad neuronal dysfunction. Med Hypotheses 2018; 118:13-18. [PMID: 30037601 DOI: 10.1016/j.mehy.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/07/2018] [Indexed: 12/25/2022]
Abstract
Earlier observers have speculated on the causal relationships between abnormal CSF circulation and a variety of neurological dysfunctions. Such speculations have been at least partially validated by recent evidence and inquiries contravening the traditional static viewpoint of CSF circulation. More contemporary inquiries establish a number of factors which influence both CSF production and absorption (sleep disturbance, neck position, cerebral metabolism, brain atrophy, medications, etc.). Thus, transient periods of abnormality are possibly mingled with periods of normality. Such episodic alterations suggest that the physiological arrangements which underpin CSF circulation may be in some ways likened to blood pressure alterations, in that long-standing CSF abnormalities may be both unappreciated and gradual, though virulent enough to cause substantial neurological injury. We suggest that cervical stenosis (blocking an important CSF decompressive pathway into the vertebral canal) is among the largely unappreciated causes of abnormal CSF circulation and may play a role in cephalad neuronal dysfunction. Such a blockage is correlated with age and easily assessed by cine MRI study. Indeed, episodic disturbances can diminish CSF cerebral flow circulation increasing deposition in cerebral parenchyma of contrary metabolic products (e.g. beta Amyloid), possibly having a causal influence on senile dementia. Additionally, cervical stenosis, by increasing posterior fossa cerebral pressure, could play a causal role in a number of afflictions, among them sleep apnea, concomitant respiratory and circulatory dysfunction, hypertension, chronic occipital headaches, tinnitus, etc. We further suggest that among those patients with substantial cervical stenosis (extensive enough to block CSF circulation in the cervical area as identified by cine MRI) appropriate comparative clinical studies could be undertaken to demarcate associations with presenile dementia, sleep disturbance and posterior fossa dysfunction. Additionally, we suggest that an intracranial monitoring implant be perfected to chronically monitor both intracranial pressure and CSF flow - a monitoring device comparable to the rather less invasive sphygmometric evaluation of blood pressure. If such speculations prove correct, different therapeutic regimens which might improve outcome could be imagined. Among them better sleep hygiene (to by position maximize CSF flow) and possibly more aggressive operative decompressive intervention to diminish cervical obstruction.
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Affiliation(s)
- Tigran Khachatryan
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States.
| | - Joe Sam Robinson
- Georgia Neurosurgical Institute, 840 Pine Street, Suite 880, Macon, GA 31210, United States
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Pennington Z, Zygourakis C, Ahmed AK, Kalb S, Zhu A, Theodore N. Immediate improvement of intraoperative monitoring signals following CSF release for cervical spine stenosis: Case report. J Clin Neurosci 2018; 53:235-237. [PMID: 29716808 DOI: 10.1016/j.jocn.2018.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
Abstract
Cervical spondylotic myelopathy (CSM) is a degenerative pathology characterized by partial or complete conduction block on intraoperative neuromonitoring. We describe a case treated using osseoligamentous decompression and durotomy for cerebrospinal fluid (CSF) release. Intraoperative monitoring demonstrated immediate signal improvement with CSF release, suggesting that clinical improvement in CSM may result from resolution of CSF flow anomalies.
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Affiliation(s)
- Zach Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Corinna Zygourakis
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - A Karim Ahmed
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Samuel Kalb
- Department of Neurosurgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Alex Zhu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
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Rowe PC, Marden CL, Heinlein S, Edwards CC. Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis. J Transl Med 2018; 16:21. [PMID: 29391028 PMCID: PMC5796598 DOI: 10.1186/s12967-018-1397-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/24/2018] [Indexed: 12/01/2022] Open
Abstract
Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a potentially disabling disorder. Little is known about the contributors to severe forms of the illness. We describe three consecutive patients with severe ME/CFS whose symptoms improved after recognition and surgical management of their cervical spinal stenosis. Methods All patients satisfied clinical criteria for ME/CFS and orthostatic intolerance, and were later found to have cervical spinal stenosis. Overall function was assessed before and after surgery using the Karnofsky score and the SF-36 physical function subscale score. Results Neurological findings included > 3+ deep tendon reflexes in 2 of 3, a positive Hoffman sign in 2 of 3, tremor in 2 of 3, and absent gag reflex in 1 of 3. The cervical spine canal diameter in the three patients ranged from 6 to 8.5 mm. One had congenital cervical stenosis with superimposed spondylosis, and two had single- or two-level spondylosis. Anterior cervical disc replacement surgery in two patients and a hybrid anterior cervical disc fusion and disc replacement in the third was associated with a marked improvement in myelopathic symptoms, resolution of lightheadedness and hemodynamic dysfunction, improvement in activity levels, and improvement in global ME/CFS symptoms. Conclusions The prompt post-surgical restoration of more normal function suggests that cervical spine stenosis contributed to the pathogenesis of refractory ME/CFS and orthostatic symptoms. The improvements following surgery emphasize the importance of a careful search for myelopathic examination findings in those with ME/CFS, especially when individuals with severe impairment are not responding to treatment.
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Affiliation(s)
- Peter C Rowe
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St., Room 2077, Baltimore, MD, 21287, USA.
| | - Colleen L Marden
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N. Wolfe St., Room 2077, Baltimore, MD, 21287, USA
| | - Scott Heinlein
- Lifestrength Physical Therapy, Inc, 110 West Road, Suite 105, Towson, MD, 21204, USA
| | - Charles C Edwards
- Maryland Spine Center, Mercy Medical Center, 301 St. Paul Place, Baltimore, MD, 21201, USA
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Abstract
We performed a systematic review on the clinical epidemiology and outcome of difficult embryo transfers (ETs) in infertility patients who present with difficult ET. We searched PubMed, ScienceDirect, and Elsevier journals from 1980 to June 2017. We aimed to determine the most successful method resulting in highest pregnancy rates (PRs) in patients with difficult ET. We identified 50 articles, in which 36 were reviewed and 15 were included. Analysis of the data collected showed that the majority of the difficult ETs were caused by cervical stenosis and the most common treatment was cervical dilation. We concluded that cervical dilation was effective at managing difficult ET. Hegar dilators used a minimum of 3 weeks before ET showed to have higher PR.
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Affiliation(s)
- Puneet Arora
- Bourn Hall Fertility Centre, Gurgaon, Haryana, India
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Speiser D, Malik S, Lanowska M, Bartens A, Blohmer JU, Mangler M. Follow-up after radical vaginal trachelectomy (RVT): patients' problems and physicians' difficulties. Arch Gynecol Obstet 2017; 296:559-64. [PMID: 28717824 DOI: 10.1007/s00404-017-4463-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Patients after radical vaginal trachelectomy (RVT) need specific follow-up treatment because their problems differ from those of other gyneco-oncologic patients. Anatomic changes after surgery complicate examinations. Recognition and treatment of these issues require physician's expertise. PATIENTS AND METHODS We evaluated the follow-up data of 70 patients who underwent RVT for early cervical cancer between 03/2010 and 12/2013. The follow-up interval in the first 2 years was 3 and 6 months in the following 2 years. We used a tailored protocol to describe the special problems after RVT. RESULTS Cervical stenosis was one of the central problems independent of time interval to RVT. Physicians' most significant problem was to locate the exact position of the neo-cervix and thus to receive valid pap smears. CONCLUSIONS Follow-up of patients after RVT needs special expertise because the symptoms differ from those after hysterectomy and examinations ensuring oncologic safety require special attention.
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Tanaka Y, Ueda Y, Kakuda M, Kubota S, Matsuzaki S, Iwamiya T, Okazawa A, Matsuzaki S, Hashimoto K, Kobayashi E, Mabuchi S, Sawada K, Tomimatsu T, Yoshino K, Kimura T. Predictors for recurrent/persistent high-grade intraepithelial lesions and cervical stenosis after therapeutic conization: a retrospective analysis of 522 cases. Int J Clin Oncol 2017; 22:921-926. [PMID: 28451844 DOI: 10.1007/s10147-017-1124-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of the study is to identify the risk factors associated with recurrent/persistent disease and cervical stenosis after conization. METHODS Five hundred twenty-two (522) cases of high-grade intraepithelial lesions treated by conization were retrospectively reviewed. Risk factors associated with recurrent/persistent disease were analyzed by univariate and multivariate analysis using a Cox hazard regression model. Factors that could potentially affect the risk of cervical stenosis were examined by univariate and by multivariate analysis using the χ 2 test and logistic regression, respectively. RESULTS Recurrent/persistent diseases and cervical stenosis occurred in 4.8% and 5.4% of the patients, respectively. Age ≥46 years [hazard ratio (HR) 3.6, 95% CI 1.36-10.3, p = 0.0092] and surgical margin involvement (HR 13.44, 95% CI 5.07-46.37, p < 0.001) were independent predictors for recurrent/persistent diseases. Age ≥46 years [odds ratio (OR) 4.27, 95% CI 1.88-10.07, p < 0.001] and shortened interval after childbirth to conization (within 12 months) (OR 5.42, 95% CI 1.42-17.41, p = 0.016) were independent risk factors for cervical stenosis. CONCLUSION Elderly patients (aged ≥46 years) are at high risk of recurrence and cervical stenosis, which may lead to unsatisfactory follow-up. Subsequent hysterectomy is beneficial to patients aged 46 or older with surgical margin involvement. Clinicians should recognize the possibility of cervical stenosis after conization during the breastfeeding period, leading to secondary infertility or hematometra.
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Affiliation(s)
- Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Mamoru Kakuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Kubota
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoko Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Iwamiya
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Akiko Okazawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kae Hashimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Seiji Mabuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Nagoshi N, Tetreault L, Nakashima H, Nouri A, Fehlings MG. Return to play in athletes with spinal cord concussion: a systematic literature review. Spine J 2017; 17:291-302. [PMID: 27836772 DOI: 10.1016/j.spinee.2016.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 08/05/2016] [Accepted: 09/12/2016] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a systematic review. PURPOSE The study aimed to evaluate whether spinal cord concussion (SCC) patients can safely return to play sports and if there are factors that can predict SCC recurrence or the development of a spinal cord injury (SCI). BACKGROUND CONTEXT Although SCC is a reversible neurologic disturbance of spinal cord function, its management and the implications for return to play are controversial. METHODS We conducted a systematic search of the literature using the keywords Cervical Spine AND Sports AND Injuries in six databases. We examined return to play in patients (1) without stenosis, (2) with stenosis, and (3) who underwent single-level anterior cervical discectomy and fusion (ACDF). We also investigated predictors for the risk of SCC recurrence or SCI. RESULTS We identified 3,655 unique citations, 16 of which met our inclusion criteria. The included studies were case-control studies or case series and reports. Two studies reported on patients without stenosis: pediatric cases returned without recurrence, whereas an adult case experienced recurrent SCC after returning to play. Seven studies described patients with stenosis. These studies included cases with and without recurrence after return to play, as well as patients who suffered SCI with permanent neurologic deficits. Three studies reported on patients who underwent an ACDF. Although some patients played after surgery without problems, several patients experienced recurrent SCC due to herniation at levels adjacent to the surgical sites. With respect to important predictors, a greater frequency of patients who experienced recurrence of symptoms or SCI following return to play had a "long" duration of symptoms (>24 hours; 36.36%) compared with those who were problem-free (11.11%; p=.0311). CONCLUSIONS There is limited evidence on current practice standards for return to play following SCC and important risk factors for SCC recurrence or SCI. Because of small sample sizes, future prospective multicenter studies are needed to determine important predictive factors of poor outcomes following return to play after SCC.
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Affiliation(s)
- Narihito Nagoshi
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Lindsay Tetreault
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada
| | - Hiroaki Nakashima
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan
| | - Aria Nouri
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, 399 Bathurst St, Toronto M5T 2S8, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Medical Sciences Building 1 King's College Circle, Room 2374, Toronto M5S 1A8, Ontario, Canada.
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Lenzi J, Nardone A, Passacantilli E, Caporlingua A, Lapadula G, Caporlingua F. Posterior Cervical Transfacet Fusion with Facetal Spacer for the Treatment of Single-Level Cervical Radiculopathy: A Randomized, Controlled Prospective Study. World Neurosurg 2017; 100:7-14. [PMID: 28065872 DOI: 10.1016/j.wneu.2016.12.125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/24/2016] [Accepted: 12/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Single-level cervical radiculopathy may be treated conservatively with cervical tractions. Posterior cervical transfacet fusion with a facetal spacer is a viable option. The aim of the present study is to compare posterior cervical transfacet fusion with conservative physical treatment in single-level cervical radiculopathy. METHODS A total of 80 patients were randomized in 2 groups, a surgical group in which patients were given posterior cervical transfacet fusion and a traction group in which patients were treated conservatively with mechanical cervical tractions. Visual analog scale for arm and neck, Neck Disability Index, and Short Form-36 (SF-36) questionnaires were administered preoperatively and after treatment up to 12 months. RESULTS After treatment, visual analog scale arm scores were greater in traction group (4.7 vs. 1.5 the day after treatment) and at follow-up controls (traction group vs. surgical group: 5.3 vs. 0.6 at 1 month, 3.6 vs. 0.3 at 6 months, 1.8 vs. 0.2 at 12 months). Neck Disability Index scores were lower in the surgical group (surgical group vs. traction group: 4.4 vs. 20.3 at 1 month, 1.3 vs. 10.5 at 6 months). SF-36 scores were greater in the surgical group (surgical group vs. traction group: 96 vs. 70 at 1 month, 96.5 vs. 82.6 at 6 months). Neck disability index and SF-36 scores were superimposable between the groups at 12-month follow-up. No adjacent-segment arthrosis or late complications were reported at 1-year follow-up in the surgical group. CONCLUSIONS posterior cervical transfacet fusion is a safe and effective procedure to treat single-level cervical radiculopathy.
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Affiliation(s)
- Jacopo Lenzi
- Neurological Center of Latium, Neurosurgery, Rome, Italy
| | | | | | - Alessandro Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Lapadula
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy
| | - Federico Caporlingua
- Department of Neurology and Psychiatry, Neurosurgery, "Sapienza" University of Rome, Rome, Italy.
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Abstract
CONTEXT/OBJECTIVE The purpose of this study was to characterize etiologies of spinal cord injury and disorders (SCI/D) in persons with and without cervical stenosis/spondylosis (CSS) and to describe clinical characteristics and underlying comorbidities in these populations. DESIGN AND SETTING We reviewed administrative data for 1954 Veterans who had onset of traumatic or non-traumatic tetraplegia during FY 1999-2007. This included 1037 with a diagnosis of CSS at or in the two years prior to SCI onset of SCI/D and 917 without a diagnosis of CSS. OUTCOME MEASURES Demographics, etiologies of SCI/D and comorbidities by CSS status. RESULTS Veterans with SCI/D and CSS were older, more likely to have incomplete injuries and more likely to be Black than those with SCI/D and no CSS. Of patients with traumatic etiologies for SCI, 35.1% had a diagnosis of CSS at the time of or in the 2 years prior to SCI onset. Of those with tetraplegia due to falls, 40.0% had CSS, whereas for other known traumatic etiologies the percentages with CSS were lower: vehicular (25.0%); sports (16.1%); and acts of violence (10.2%). Total comorbidity scores measured by the Charlson co morbidity index and CMS Hierarchical Condition Category (CMS-HCC) were higher in those with CSS and SCI/D compared to those with SCI/D without CSS (P < 0.0001 respectively). CONCLUSIONS CSS is commonly present in patients with new traumatic tetraplegia. Falls are a particularly important potentially modifiable risk for SCI in patients with CSS.
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Affiliation(s)
- Stephen P Burns
- a Spinal Cord Injury Service , Department of Veterans Affairs- Puget Sound Health Care System , Seattle , WA , USA.,b Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Frances Weaver
- c Director, Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital , Chicago , IL , USA.,d Stritch School of Medicine , Loyola University , Chicago , IL , USA
| | - Amy Chin
- e Edward J. Hines, Jr. Veterans Affairs Hospital , Hines , IL , USA
| | - Jelena Svircev
- a Spinal Cord Injury Service , Department of Veterans Affairs- Puget Sound Health Care System , Seattle , WA , USA
| | - Laura Carbone
- f Charlie Norwood Veterans Affairs Medical Center , Augusta , GA , USA.,g Medical College of Georgia, Department of Medicine , Augusta University , Augusta , GA , USA
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Cleveland C, Walker H. Spinal cord injury following operative shoulder intervention: A case report. J Spinal Cord Med 2015; 38:548-50. [PMID: 24679185 PMCID: PMC4612212 DOI: 10.1179/2045772314y.0000000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT Cervical myelopathy is a spinal cord dysfunction that results from extrinsic compression of the spinal cord, its blood supply, or both. It is the most common cause of spinal cord dysfunction in patients greater than 55 years of age. FINDINGS A 57-year-old male with right shoulder septic arthritis underwent surgical debridement of his right shoulder and sustained a spinal cord injury intraoperatively. The most likely etiology is damage to the cervical spinal cord during difficult intubation requiring multiple attempts in this patient with underlying asymptomatic severe cervical stenosis. CONCLUSION Although it is not feasible to perform imaging studies on all patients undergoing intubation for surgery, this patient's outcome would suggest consideration of inclusion of additional pre-surgical screening examination techniques, such as testing for a positive Hoffman's reflex, is appropriate to detect asymptomatic patients who may have underlying cervical stenosis.
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Affiliation(s)
| | - Heather Walker
- Correspondence to: Heather Walker, Department of Physical Medicine and Rehabilitation, School of Medicine, University of North Carolina at Chapel Hill, 101 Manning Drive, CB #7200, Chapel Hill, NC 27599, USA;
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Lubelski D, Abdullah KG, Alvin MD, Wang TY, Nowacki AS, Steinmetz MP, Ransohoff RM, Benzel EC, Mroz TE. Clinical outcomes following surgical management of coexistent cervical stenosis and multiple sclerosis: a cohort-controlled analysis. Spine J 2014; 14:331-7. [PMID: 24239804 DOI: 10.1016/j.spinee.2013.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 08/29/2013] [Accepted: 11/08/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The presentation of myelopathy in patients with the concomitant diagnosis of cervical stenosis (CS) and multiple sclerosis (MS) complicates both diagnosis and treatment because of the similarities of presentation and disease progression. There are only a few published case series that examine this unique patient population. PURPOSE To define the demographic features and presenting symptoms of patients with both MS and CS and to investigate the immediate and long-term outcomes of surgery in patients with MS and CS. STUDY DESIGN/SETTING Matched cohort-controlled retrospective review of 77 surgical patients in the MS group and 77 surgical patients in the control group. Outcome measures were immediate and long-term postoperative neck pain, radiculopathy, and myelopathy; Nurick Disability and modified Japanese Orthopaedic Association scores were collected as well. METHODS Retrospective review was performed for all patients presenting at one institution between January 1996 and July 2011 with coexisting diagnoses of MS and CS who had presenting symptoms of myelopathy and who then underwent cervical decompression surgery. Each study patient was individually matched to a control patient of the same gender and age that did not have MS, but that did have cervical spondylotic myelopathy or myeloradiculopathy. Each control patient underwent the same surgical procedure within the same year. RESULTS A total of 154 patients were reviewed, including 77 MS patients and 77 control patients, for an average follow-up of 58 months and 49 months, respectively. Patients in the control group were more likely to have preoperative neck pain (78% vs. 47%; p=.0001) and preoperative radiculopathy (90% vs. 75%; p=.03) than their counterparts in the MS group. Patients in the MS group had a significantly lower rate of postoperative resolution of myelopathic symptoms in both the short-term (39% in the MS group did not improve vs. 23% in the control group; p=.04) and the long-term (44% in the MS group did not improve vs. 19% in the control group; p=.004). Preoperative myelopathy scores were worse for the MS cohort as compared with the control cohort (1.8 vs. 1.2 in the Nurick scale, p<.0001; 13.7 vs. 15.0 in the modified Japanese Orthopaedic Association scale, p=.002). This difference in scores became even greater at the last follow-up visit with Nurick scores of 2.4 versus 0.9 (p<.0001) and modified Japanese Orthopaedic Association scores of 16.3 versus 12.4 (p<.0001) for the MS and control patients, respectively. CONCLUSIONS Myelopathic patients with coexisting MS and CS improve after surgery, although at a lower rate and to a lesser degree than those without MS. Therefore, surgery should be considered for these patients. MS patients should be informed that myelopathy symptoms are less likely to be alleviated completely or may only be alleviated temporarily because of progression of MS and that surgery can help alleviate neck pain and radicular symptoms.
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