Degenerative Cervical Myelopathy Research Articles

Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes.

This study aimed to examine whether preoperative cervical muscle size, composition, and asymmetry from magnetic resonance imaging (MRI) can predict post-operative outcomes in patients with degenerative cervical myelopathy (DCM). A total of 171 patients with DCM were included. Relative total cross-sectional area (RCSA), functional CSA (fat-free area, FCSA), ratio of FCSA/CSA (fatty infiltration) and asymmetry of the multifidus (MF) and semispinalis cervicis (SCer) together (MF + SCer), and cervical muscle as a group (MF, SCer, semispinalis capitis, and splenius capitis) were obtained from T2-weighted axial MR images at the mid-disk, at the level of maximum cord compression and the level below. Univariate and multivariate linear regression analyses were used to assess the relationship between baseline cervical muscle measurements of interest with the modified Japanese Orthopedic Association (mJOA), Nurick Classification, Neck Disability Index (NDI), and SF-36 health survey at 6-month and 12-month post-surgery. Lower RCSA of MF + SCer, less CSA MF + SCer asymmetry and greater FCSA/CSA for the cervical muscle group (e.g., less fatty infiltration), and younger age were significant predictors of higher mJOA scores (e.g., less disability) at 6-month and 12-month post-surgery (all p < 0.05). Greater CSA asymmetry in MF + SCer and lower FCSA/CSA (e.g., more fatty infiltration) for the cervical muscle group were significant predictors of higher Nurick scores (e.g., more disability) at 6-month and 12-month post-surgery (all p < 0.05). Lower FCSA MF + Scer asymmetry, lower FCSA/CSA asymmetry of the muscle group, and greater RCSA MF + SCer were significant predictors of higher NDI scores at 6-month and 12-month post-surgery. Finally, greater FCSA/CSA asymmetry of the MF + SCer, greater FCSA asymmetry of the muscle group, greater RCSA of the muscle group, and greater CSA asymmetry of MF + SCer were significant predictors of lower post-operative SF-36 scores at 6- and 12-month post-surgery. Our result suggested that cervical paraspinal muscle morphology, specifically greater asymmetry, and fatty infiltration may be important predictors of functional recovery and post-surgical outcomes in patients with DCM.

Workshop (Clinical/Best Practice Implementation) ID 2000428

Background/Objectives This workshop aims to overview degenerative cervical myelopathy (DCM), which is the most common cause of non-traumatic spinal cord injury across the world. DCM is estimated to affect approximately 1 in 50 adults; however, &amp;lt; 10% receive a diagnosis, and lifelong disability remains a common outcome. Upon completion of this workshop, attendees will (1) understand the diagnostic criteria and investigations for DCM and avoid misdiagnosis in the primary care level; (2) recognise the indications and role of surgical treatment; (3) comprehend the impact of prehabilitation and rehabilitation; (4) understand the alternatives for non-operative management of DCM; and (5) appreciate the importance of raising awareness of this disease. Methods/Overview This workshop will review the diagnostic criteria and investigations for individuals with different degrees of DCM, the current clinical practice guidelines for management of DCM with focus on the role of surgical decompression of spinal cord, the role of prehabilitation and rehabilitation, current non-operative options for patients with DCM, and some initiatives focused on raising awareness of this disease. Results This workshop will include lectures (10-15 minutes each) with illustrative cases followed by open discussion on the following topics: (i) diagnosis, misdiagnosis and investigations in DCM; (ii) surgical management of DCM; (iii) prehabilitation and rehabilitation in DCM; and (iv) non-operative management of DCM. Conclusions Although DCM is the most common cause of non-traumatic spinal cord disease, there is a need for the development of a tailored and multi-disciplinary care framework for management of DCM, which would improve patients’ outcomes. Greater awareness of DCM among healthcare professionals is urged to avoid misdiagnosis and mitigate the long-term consequences of this disease.

Are quantitative measures of the Romberg test correlated to lower limb pathology in patients with degenerative cervical myelopathy?

Are quantitative measures of the Romberg test correlated to lower limb pathology in patients with degenerative cervical myelopathy?

Comparative Study between Anterior and Posterior Approaches in Management of Cervical Spondylotic Myelopathy

Background The best surgical approach for management of degenerative cervical myelopathy remains area of debate between spinal surgeons. The purpose of this study compare between anterior approach (anterior cervical discectomy with fusion) and posterior approach (laminectomy with and without fusion) for treatment of multilevel spondylotic myelopathy according to clinical, radiological outcomes, recovery rates and complications. Material and Methods A total of 20 patients were operated by anterior cervical discectomy and fusion (ACDF) and 20 patients were operated by cervical laminectomy with and without fusion in this study. Preoperative and postoperative clinical assessment were done using modified Japanese Orthopedic Association (mJOA) score and Myelopathy scale (MS). Postoperative complications, recovery rate and intraoperative blood loss are recorded. Preoperative and postoperative radiological analysis were done using Cobb angle measurement (C2-7 angle) and canal diameter assessment by measuring the canal through the center of each vertebra and intervertebral discs (C2–C7) on 10 transverse planes on mid-sagittal T2WI image. Results There was significant decrease in pre-operative mJOA scale in posterior approach group; compared to anterior group (P = 0.41). There was highly significant decrease in duration of symptoms in anterior approach group; compared to anterior group (P &amp;lt; 0.01) and significant decrease in pre-operative MS scale in anterior approach group; compared to anterior group (P &amp;lt; 0.05). There is non-significant difference as regards post-operative mJOA scale and MS scale between anterior and posterior group (p &amp;gt; 0.05). Although recovery rate was higher in anterior group than posterior group (49.5 ± 27.2 vs 39.51 ± 11.30), but finally There was no significant difference as regards postoperative recovery, improvement and complications rates (p &amp;gt; 0.05). postoperative canal diameter change was greater in posterior surgery than anterior group (11.1 ± 1.98 vs 9.5 ± 0.76). Reoperation rate was higher in anterior group. Postoperative C5 palsy and axial neck pain were higher in posterior group. Conclusions Both anterior and posterior approaches were successful to treat multilevel CSM, but no definitive surgical approach was proved for management of CSM and each case should be evaluated carefully for determination of best surgical approach according to preoperative Cobb angle and canal diameter.

131. The role of surgery on pain in degenerative cervical myelopathy: a pooled analysis of the CSM-NA, CSM-I, and CSM-Protect clinical trials

131. The role of surgery on pain in degenerative cervical myelopathy: a pooled analysis of the CSM-NA, CSM-I, and CSM-Protect clinical trials

32. Timing of recovery after surgery for patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

32. Timing of recovery after surgery for patients with degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

P129. The degenerative cervical myelopathy subjective and objective score (DCM-SOS): a novel outcome measure

P129. The degenerative cervical myelopathy subjective and objective score (DCM-SOS): a novel outcome measure

37. What is the optimal surgical approach for mild and symptomatic degenerative cervical myelopathy? An individual patient data meta-analysis of 1,031 cases

37. What is the optimal surgical approach for mild and symptomatic degenerative cervical myelopathy? An individual patient data meta-analysis of 1,031 cases

Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis

Early surgery compared to nonoperative management for mild degenerative cervical myelopathy: a cost-utility analysis

55. Surgical approach is associated with postoperative C5 palsy after decompression for degenerative cervical myelopathy: an analysis of the multicenter, prospective, randomized CSM-Protect clinical trial

55. Surgical approach is associated with postoperative C5 palsy after decompression for degenerative cervical myelopathy: an analysis of the multicenter, prospective, randomized CSM-Protect clinical trial

36. Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

36. Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

Brainstem and subcortical regions volume loss in patients with degenerative cervical myelopathy and its association with spinal cord compression severity

BackgroundIn recent years, structural and functional reorganization of the brain and changes in brainstem structural connectivity have been shown in patients with degenerative cervical myelopathy (DCM). We hypothesized that volume loss in the basal ganglia, thalami, and brainstem structures exists and is associated with spinal cord compression severity in patients with DCM. MethodsForty-seven patients with DCM and 25 patients with cervical radiculopathy were evaluated using cervical spinal cord and brain magnetic resonance imaging (MRI). Brainstem structures, basal ganglia, and thalami volumes were evaluated with FreeSurfer and compared between groups with correction for individual intracranial volume, as well as patient age and sex. Additionally, spinal cord MRI data were analysed with the Spinal Cord Toolbox, and cross-sectional area (CSA) and fractional anisotropy (FA) values were calculated. Correlations between MR-morphometry data and spinal cord structural changes, as well as disease duration, were also evaluated in patients with DCM. ResultsA statistically significant reduction in the volume of the whole brainstem was revealed in the DCM group compared to the radiculopathy group (p < 0.01, FDR-corrected). Additionally, reductions in medulla oblongata, pons and midbrain volumes were found in patients with DCM (p < 0.01, p < 0.01 and p < 0.05, respectively, FDR-corrected). Additionally, a trend in the loss of volume of the left putamen was found (p = 0.087, FDR-corrected). Furthermore, medulla oblongata volume was correlated with spinal cord compression severity (R = 0.54, adjusted p < 0.001) and white matter damage (R = 0.46, adjusted p < 0.05) in patients with DCM. Negative correlations between the duration of the disease and the severity of spinal cord compression (R = −0.42, adjusted p < 0.05) and white matter damage (R = −0.49, adjusted p < 0.05) were also revealed, as well as a trend toward a negative association between the duration of the disease and the volume of the medulla oblongata (R = −0.35; adjusted p < 0.1). ConclusionsWe revealed a reduction in the volume of brainstem structures in patients with DCM compared to patients with radiculopathy. Moreover, we found that these changes are associated with cord compression severity.

An innovative approach to assess spinal canal expansion following French-door cervical laminoplasty by intraoperative ultrasonography.

To investigate the feasibility and effectiveness of applying intraoperative ultrasound (IOUS) to evaluate spinal canal expansion in patients undergoing French-door cervical laminoplasty (FDCL). Twenty-five patients who underwent FDCL for multilevel degenerative cervical myelopathy were prospectively recruited. Formulae describing the relationship between laminoplasty opening angle (LOA) and laminoplasty opening size, the increase in sagittal canal diameter and the spinal canal area were deduced with trigonometric functions. The LOA was measured with IOUS imaging during surgery, and other spinal canal parameters were assessed. Actual spinal canal enlargement was verified on postoperative CT images. Linear correlation analysis and Bland‒Altman analysis were used to evaluate correlation and agreement between the intraoperative and postoperative measurements. The LOA at C5 measured with IOUS was 27.54 ± 3.12°, and it was 27.23 ± 3.02° on postoperative CT imaging. Linear correlation analysis revealed a significant correlation between IOUS and postoperative CT measurements (r = 0.88; p < 0.01). Bland-Altman plots showed good agreement between these two methods, with a mean difference of 0.30°. For other spinal canal expansion parameter measurements, correlation analysis showed a moderate to a high degree of correlation (p < 0.01), and Bland-Altman analysis indicated good agreement. In conclusion, during the French-door cervical laminoplasty procedure, application of IOUS can accurately evaluate spinal canal expansion. This innovative method may be helpful in improving surgical accuracy by enabling the operator to measure and determine canal enlargement during surgery, leading to ideal clinical outcomes and fewer postoperative complications. The use of intraoperative ultrasonography to assess spinal canal expansion following French-door cervical laminoplasty may improve outcomes for patients undergoing this procedure by providing more accurate measurements of spinal canal expansion. • Spinal canal expansion after French-door cervical laminoplasty substantially influences operative prognosis; insufficient or excessive lamina opening may result in unexpected outcomes. • Prediction of spinal canal expansion during surgery was previously impracticable, but based on this study, intraoperative ultrasonography offers an innovative approach and strongly agrees with postoperative CT measurement. • Since this is the first research to offer real-time canal expansion guidance for cervical laminoplasty, it may improve the accuracy of the operation and produce ideal clinical outcomes with fewer postoperative complications.

Adverse effects of frailty on the outcomes of surgery for degenerative cervical myelopathy: results from a prospective multicenter international data set of 757 patients.

The goal of this study was to determine the effect of the degree of frailty on long-term neurological and functional outcomes after surgery for degenerative cervical myelopathy (DCM). A combined database of patients enrolled in the Cervical Spondylotic Myelopathy-North America and Cervical Spondylotic Myelopathy-International prospective international multicenter observational studies who underwent surgery for DCM was used as the source data. All patients underwent baseline and follow-up assessment at 2 years after surgery for functional, disability, and quality of life measurements (modified Japanese Orthopaedic Association [mJOA] scale, Neck Disability Index, SF-36 physical and mental component summary scores). Patients were separated into 4 groups according to their baseline modified frailty index 5-point scale score: not frail, pre-frail, frail, and severely frail. Differences among groups were analyzed at baseline and at 2 years after surgery, including change in scores (delta values) and the odds ratio of achieving the minimum clinically important difference (MCID) through univariate and multivariable logistic regression adjusting for age, approach, number of levels treated, and sex. A total of 757 patients (63% male) with a mean age of 56 (95% CI 55.5-57.2) years were included: 470 patients underwent an anterior approach, 310 had a posterior approach, and 23 had a combined anterior/posterior approach. A total of 50% (n = 378) of patients were classified as not frail, with 33% (n = 250) pre-frail, 13% (n = 101) frail, and 4% (n = 28) severely frail. The baseline mJOA score was significantly lower with increasing frailty (14.00 [95% CI 13.75-14.19] for not frail vs 9.71 [95% CI 9.01-10.42] for severely frail patients; p < 0.05), but the change at 2 years was not significantly different among all groups (2.43 [95% CI 2.16-2.71] for not frail vs 2.56 [95% CI 1.10-4.02] for severely frail). The SF-36 delta values were also not different among groups, but significantly worse at baseline with increasing frailty. The odds ratio of achieving MCID for mJOA was significantly higher in the not frail group (1.89 [95% CI 1.36-2.61]; p < 0.05) compared to the other frailty cohorts, which remained after adjusting for age, approach, levels treated, and sex. The odds ratio of achieving MCID for the SF-36 domains was similar among all frailty groups. Increasing frailty is associated with worse baseline functional and quality of life measures in patients undergoing surgery for DCM. Frailty does not affect the magnitude of improvement in outcome measures after surgery, but reduces the chance of achieving the MCID for functional impairment significantly. Preoperative frailty assessment can therefore help guide clinicians in managing expectations after surgery for DCM. Potentially modifiable factors should be optimized in frail patients preoperatively to enhance functional outcomes.

Spine

The August 2023 Spine Roundup360 looks at: Changes in paraspinal muscles correspond to the severity of degeneration in patients with lumbar stenosis; Steroid injections are not effective in the prevention of surgery for degenerative cervical myelopathy; A higher screw density is associated with fewer mechanical complications after surgery for adult spinal deformity; Methylprednisolone following minimally invasive lumbar decompression: a large prospective single-institution study; Occupancy rate of pedicle screw below 80% is a risk factor for upper instrumented vertebral fracture following adult spinal deformity surgery; Deterioration after surgery for degenerative cervical myelopathy: an observational study from the Canadian Spine Outcomes and Research Network.

Developing predictive models for surgical outcomes in patients with degenerative cervical myelopathy: a comparison of statistical and machine learning approaches

BACKGROUND CONTEXTMachine learning (ML) is widely used to predict the prognosis of numerous diseases. PURPOSEThis retrospective analysis aimed to develop a prognostic prediction model using ML algorithms and identify predictors associated with poor surgical outcomes in patients with degenerative cervical myelopathy (DCM). STUDY DESIGNA retrospective study. PATIENT SAMPLEA total of 406 symptomatic DCM patients who underwent surgical decompression were enrolled and analyzed from three independent medical centers. OUTCOME MEASURESWe calculated the area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model. METHODSThe Japanese Orthopedic Association (JOA) score was obtained before and 1 year following decompression surgery, and patients were grouped into good and poor outcome groups based on a cut-off value of 60% based on a previous study. Two datasets were fused for training, 1 dataset was held out as an external validation set. Optimal feature-subset and hyperparameters for each model were adjusted based on a 2,000-resample bootstrap-based internal validation via exhaustive search and grid search. The performance of each model was then tested on the external validation set. RESULTSThe Support Vector Machine (SVM) model showed the highest predictive accuracy compared to other methods, with an AUC of 0.82 and an accuracy of 75.7%. Age, sex, disease duration, and preoperative JOA score were identified as the most commonly selected features by both the ML and statistical models. Grid search optimization for hyperparameters successfully enhanced the predictive performance of each ML model, and the SVM model still had the best performance with an AUC of 0.93 and an accuracy of 86.4%. CONCLUSIONSOverall, the study demonstrated that ML classifiers such as SVM can effectively predict surgical outcomes for patients with DCM while identifying associated predictors in a multivariate manner.

Demographic and Clinical Characteristics of Patients With Cervical Spine Degeneration Reveal Frequent Cervicolumbar Tandem Spinal Stenosis in Mexico.

Limited literature exists regarding the differences in demographics, causes, comorbidities, presentation, and structural changes associated with cervical spine degeneration in patients from distinct geographic regions. The authors aimed to evaluate the demographic and clinical characteristics of patients with cervical spine degeneration admitted to a single center in Mexico. This study enrolled patients with degenerative disease of the cervical spine. Clinical data were retrieved from medical records and retrospectively characterized. A total of 50 patients with cervical spine degeneration were included in the analysis. Of these, 26% were men with a median age of 54 years. Hypertension, depression, anxiety, obesity, and alcohol consumption were presented in about a quarter of the participants. In addition, we observed hypertriglyceridemia and hypercholesterolemia in 72% and 46% of participants, respectively. The median duration of symptoms was 11 months, including radicular arm/neck pain (80%), tingling (80%), reduced muscle strength (48%), and gait disturbances (48%). Forty percent of patients had 2 cervical segments radiologically involved, mainly at C5-C6, with changes such as disc herniation (88%), foraminal stenosis with nerve root compression (67%), reduced spinal canal-to-vertebral body ratio (38%), and ligamentum flavum hypertrophy (24%). Also, 22% of patients showed degenerative cervical myelopathy. Strikingly, 48% of enrolled individuals showed cervicolumbar tandem spinal stenosis, mainly in L4-L5 and L5-S1, who were generally older, had a longer duration of symptoms, and had a higher comorbidity burden, including hyperglycemia, hypertension, and depression. The demographic and clinical characteristics of degenerative cervical spine disease in Mexico differ with respect to other geographical regions by a younger age of diagnosis, a high frequency of cardiovascular, metabolic, and mental health comorbidities, and an increased prevalence of concomitant lumbar spinal stenosis. Our findings reveal a considerably high burden of cervicolumbar tandem spinal stenosis as a distinctive feature of Mexican patients with cervical spine degeneration.

Probabilistic graphical modelling using Bayesian networks for predicting clinical outcome after posterior decompression in patients with degenerative cervical myelopathy

Background Probabilistic graphical modelling (PGM) can be used to predict risk at the individual patient level and show multiple outcomes and exposures in a single model. Objective To develop PGM for the prediction of clinical outcome in patients with degenerative cervical myelopathy (DCM) after posterior decompression and to use PGM to identify causal predictors of the outcome. Methods We included data from 59 patients who had undergone cervical posterior decompression for DCM. The candidate predictive parameters were age, sex, body mass index, trauma history, symptom duration, preoperative and last Japanese Orthopaedic Association (JOA) scores, gait impairment, claudication, bladder dysfunction, Nurick grade, American Spinal Injury Association (ASIA) grade, smoking, diabetes mellitus, cardiopulmonary disorders, hypertension, stroke, Parkinson’s disease, dementia, psychiatric disorders, arthritis, ossification of the posterior longitudinal ligament, cord signal change, postoperative kyphosis and the cord compression ratio. Results In regression analyses, preoperative JOA (PreJOA) score, presence of a psychiatric disorder, and ASIA grade were identified as significant factors associated with the last JOS score. Dementia, sex, PreJOA score and gait impairment were causal factors in the PGM. Sex, dementia and PreJOA score were direct causal factors related to the last follow-up JOA (LastJOA) score. Being female, having dementia, and having a low PreJOA score were significantly related to having a low LastJOA score. Conclusions The causal predictors of surgical outcome for DCM were sex, dementia and PreJOA score. Therefore, PGM may be a useful personalized medicine tool for predicting the outcome of patients with DCM.

Differences of spinal cord gadolinium enhancement features of neuromyelitis optica spectrum disorder and long-segment degenerative cervical myelopathy.

Neuromyelitis optica spectrum disorder (NMOSD) and long-segment degenerative cervical myelopathy (DCM) may have a similar appearance on MRI. This study aimed to identify the differences in spinal cord gadolinium enhancement features between NMOSD and long-segment DCM. Spinal cord gadolinium enhancement of 27 NMOSD patients and 30 long-segment DCM patients were retrospectively analyzed. Enhancements were evaluated for their number, length, location on the sagittal images, distribution on the axial images, and form on the sagittal images. The Wilcoxon rank sum test was performed to compare numerical variables. The Pearson chi-squared test was performed to compare categorical variables. The median number of enhanced lesions (p < 0.05), the median length of the enhancements (p < 0.05), and the location of enhancement on sagittal images (p < 0.05) of NMOSD patients and long-segment DCM patients showed significant differences. The axial distribution of enhancements did not show a significant difference between NMOSD and long-segment DCM patients (p = 0.115). On the sagittal images, linear and ring-formed enhancements were observed in 10 (27.0%) and 17 (63.0%) NMOSD patients, respectively. The enhancements in long-segment DCM patients had a transverse band or pancake-like appearance in 15 (50%) patients and an irregular flake-like appearance with a longitudinally oriented long axis in 15 patients (50%). By analyzing the number, length, location, and form of the gadolinium enhancements, NMOSD and long-segment DCM could be well-differentiated.

Secondary analysis of a James Lind Alliance priority setting partnership to facilitate knowledge translation in degenerative cervical myelopathy (DCM): insights from AO Spine RECODE-DCM

ObjectivesTo explore whether a James Lind Alliance Priority Setting Partnership could provide insights on knowledge translation within the field of degenerative cervical myelopathy (DCM).DesignSecondary analysis of a James Lind Alliance...