Surgical results for cervical spondylotic myelopathy with inconsistent between deep tendon reflex findings and magnetic resonance imaging findings

BACKGROUND

To evaluate the surgical results of patients with cervical spondylotic myelopathy (CSM) with inconsistency between deep tendon reflex findings and cervical magnetic resonance imaging (MRI) findings and to analyze the differences between patients with good and poor surgical outcomes.

METHODS

We evaluated 50 subjects with CSM (30 males, 20 females; mean age: 70.4 years) who underwent posterior surgery and were followed for at least 1 year postoperatively. Matched CSM was defined as a consistent preoperative neurological pattern determined by deep tendon reflex and cervical MRI T2-weighted high-signal intramedullary area or stenosis in the most cranial compression levels. A lack of consistency was classified as unmatched CSM. Recovery rate (RR) according to Japanese Orthopaedic Association (JOA) scoring preoperatively and at 1 year postoperatively were compared between the groups.

RESULTS

The matched and unmatched CSM group included 27 subjects (13 males, 14 females; mean age: 68.2 years) and 23 subjects (17 males, 6 females; mean age: 72.8 years), respectively. RR was significantly higher in the matched CSM group (56.1 ± 3.7 % vs 36.8 ± 2.7 %; p = 0.002). Unmatched CSM was significantly associated with a lower RR independently of sex, patient age, surgical procedure, preoperative JOA score, diagnosis levels, and complication of diabetes.

CONCLUSIONS

Postoperative JOA score RR was significantly diminished among unmatched CSM patients comprising of 46% of cases. Some patients with unmatched CSM had multiple levels of spinal canal stenosis, foraminal stenosis, and peripheral neuropathy, suggesting that surgical results were poorer than those of matched CSM.

Critical Hypermagnesemia in Preeclamptic Women Under a Magnesium Sulfate Regimen: Incidence and Associated Risk Factors

Magnesium sulfate is used as prophylaxis and treatment of severe preeclampsia/eclampsia, albeit its safety and toxicity are a concern. We designed this study to estimate the incidence of critical hypermagnesemia in severely preeclamptic women under a magnesium sulfate regimen at 8 h following its administration and to identify the associated risk factors as the primary outcomes. Also, secondary outcomes were to compare baseline characteristics, laboratory findings, and maternal-neonatal complications stratified by the baseline serum magnesium (Mg²⁺) in those women, and to assess the degree of agreement between patellar reflex and serum Mg²⁺ concentration 8 h following magnesium sulfate administration. We conducted a retrospective study including severely preeclamptic women receiving magnesium sulfate from June 2016 to May 2021. We enrolled 429 women in the study. Two-hundred sixty-one (60.8%) of the included women developed critical hypermagnesemia. Preeclamptic women with high baseline serum Mg²⁺ concentration demonstrated significantly affected renal functions, hepatic transaminase activities, and low platelet count as well as more reported maternal complications compared to those with low baseline serum Mg². Multivariable logistic regression revealed that a lower gestational age, a higher uric acid concentration, and a higher baseline serum Mg²⁺ concentration were independently associated with an increased risk of critical hypermagnesemia. The agreement between deep tendon reflex assessment and serum Mg²⁺ concentration was slight although not significant. The maternal-neonatal outcomes were non-significant in women with critical hypermagnesemia. More vigilant monitoring through assessment of both serum Mg²⁺ concentration and deep tendon reflex should be considered especially in high-risk women.

Clinical availability of the deep tendon reflex test using a novel apparatus in healthy subjects

[Purpose] The aim of this study was to investigate the clinical usefulness of a novel apparatus intended to improve the consistency and reliability of the deep tendon reflex (DTR) test. [Subjects] The participants included 50 healthy adults (25 male and 25 female) between 20 and 31 years of age who showed no knee abnormalities upon physical examination. [Methods] The intraclass correlation coefficient (ICC) was used to verify inter-rater reliability for two parameters examined in the DTR test using a newly designed apparatus. These parameters were the patellar reflex amplitude and first knee extension angle. Pearson's product correlation coefficient was then used to examine the correlation between these two parameters. [Results] The inter-rater reliability analysis showed a high correlation between the examiners for both DTR parameters (ICCs = 0.91-0.96). In addition, a significant positive correlation was observed between the two parameters (r = 0.91). [Conclusion] The results show that it is possible to use the novel apparatus described herein to obtain reliable results in the DTR test.