Cervical Spondylosis Myelopathy Research Articles

Leverage of applying diffusion tensor imaging (DTI) indices in assessment of cervical spondylotic myelopathy

BackgroundCervical spondylotic myelopathy (CSM) is the most prevalent form of dysfunction in the cervical cord. For best results, CSM must be identified and treated quickly, before spinal cord injury develops. We aimed at determining the diagnostic value of quantitative and qualitative diffusion tensor imaging (DTI) indices in the assessment of CSM. Thirty patients were included in this prospective study with clinically suspected CSM of both sexes. This study aimed at determining the diagnostic value of quantitative and qualitative DTI indices in early assessment of CSM and subsequently early and proper management decision rendering better clinical outcome.ResultsThis prospective study included 30 patients: with clinically suspected CSM with a mean age of 51.88 ± 10.28 years. Patients with CSM were graded to 3 grades, mild (No. = 17), moderate (No. = 13) and severe (No. = 0) according to the modified Japanese orthopedic association (mJOA) grading system. Correlation test was performed between mJOA grades of severity with fractional anisotropy (FA), apparent diffusion coefficient (ADC) and T2 cord signal. We found a negative correlation between ADC and FA with Spearman’s rho value of − 0.612 and “P value 0.000” (P value < 0.05), a positive correlation between FA with mJOA clinical score with Spearman’s rho value of − 0.504 & “P value 0.036” (P value < 0.05) and a negative correlation between ADC and mJOA clinical score with Spearman’s rho value of 0.385 and P value 0.005 (P value < 0.05), and no significant correlation was found between mJOA clinical score and T2 hyperintense signal with Spearman’s rho value of − 0.304 and “P value 0.102” (P value < 0.05). Qualitative maps grading by 3D tractography images were done, and 18 patients in the study (60%) showed homogenous intact fiber tracts (grade I), 9 patients (30%) showed reduction or alteration of anisotropy or mixed colors intensity (grade II), and 3 patients (10%) showed fiber tract disruption or displaced cord (grade III). Three DTI parameters (other than FA and ADC) were measured, and two of them show significant difference between their measures in the stenotic and non-stenotic portions of the spinal cord—RA (P value = 0.00) and RD (P value = 0.00).ConclusionsWe concluded that DTI is a crucial tool for early diagnosis and grading of CSM (cervical spondylosis myelopathy)—quantitatively and qualitatively—hence, it should be routinely integrated with conventional cervical spine MRI in case of clinically or radiologically suspected cervical cord compression, as the FA parameter together with the clinical assessment formulates the management plan decision for the CSM whether surgical or non-surgical and depicts the need for early surgical decision rendering better clinical outcome compared to that based on T2 hyperintense cord signal.

1087 Large Incidence and Risk Factors Meta-analysis of Dysphagia in Over 132,000 Anterior, Posterior, and Hybrid Surgeries for Cervical Spondylosis Myelopathy

INTRODUCTION: Surgical management of Cervical Spondylotic Myelopathy (CSM) is associated with complications with devastating impacts. Dysphagia is one of these major complications with the incidence rate being not completely known in different surgical approaches. METHODS: PubMed/MEDLINE, SCOPUS, and Cochrane were systematically searched until January 2023. Rates and risk of complications were assessed. Meta-analysis of rates and risks was performed with generalized linear mixed model (GLMM) and inverse variance method, respectively, and compared between techniques. RESULTS: 1196 citations were screened and 39 studies with 60 instances of dysphagia incidence/risk factors reports from over 132,442 patients were identified. Dysphagia’s overall incidence rate was 4.98%[95% confidence interval 3.23-7.61] and was significantly different between surgery groups (Chi2 p &lt; 0.01). It was found in 7.97% [4.95–12.57] of anterior surgeries, 1.52% [0.94–2.45] of posterior ones, and 11.25% [3.38–31.44] of hybrid techniques (statistical comparison: P &lt; A &lt; H). Advanced age (&gt;65) risked dysphagia significantly (OR 1.38 [95%CI 1.11-1.71]). CONCLUSIONS: Chances of posterior surgery being complicated with dysphagia is not negligible and should be discussed with patient before surgery, especially with older adults.

The efficacy of virtual reality technology for the postoperative rehabilitation of patients with cervical spondylotic myelopathy (CSM): a study protocol for a randomized controlled trial

BackgroundPatients with cervical spondylosis myelopathy (CSM) may experience severe neurological dysfunction due to untimely spinal cord compression after surgery. These disorders may lead to sensory and motion disorders, causing considerable psychological distress. Recent studies found that virtual reality (VR) technology can be an effective tool for treating spinal cord injuries. Owing to this discovery, we developed an exploratory research project to investigate the impact of this intervention on the postoperative recovery of patients with CSM.MethodsThe purpose of this randomized controlled trial was to evaluate the efficacy of combining VR technology with conventional rehabilitation strategies for the postoperative rehabilitation of patients with CSM. A total of 78 patients will be recruited and randomized to either the conventional rehabilitation group or the group subjected to VR technology combined with conventional rehabilitation strategies. The Japanese Orthopaedic Association (JOA) scale will be the main tool used, and secondary outcomes will be measured via the visual analogue scale (VAS), neck disability index (NDI), and functional MRI (fMRI). The data analysis will identify differences between the intervention and control groups as well as any relationship between the intragroup changes in the functional area of the brain and the subjective scale scores after the intervention.DiscussionThe aim of this trial is to investigate the effect of VR training on the postoperative rehabilitation of patients with CSM after 12 intervention treatments. Positive and negative outcomes will help us better understand the effectiveness of the intervention and its neural impact. If effective, this study could provide new options for the postoperative rehabilitation of patients with CSM.Trial registrationChinese Clinical Trial Registry (ChiCTR2300071544). Registered 17 May 2023, https://www.chictr.org.cn/.

[Study on the correlation between the thickness of superficial fascia at Dazhui(GV14) and cervical spondylosis].

To observe the correlation between the thickness of superficial fascia at Dazhui (GV14) acupoint and cervical spondylosis, so as to explore the essence of its morphological and structural changes of acupoint sensitivity. A retrospective study was conducted. According to the diagnostic criteria of "Guidelines for Diagnosis, Treatment and Rehabilitation of Cervical Spondylosis" (2017), 344 cases of cervical spine magnetic resonance imaging (MRI) examination were included and divided into control group (73 cases) and observation group (271 cases). The control group was healthy population, and the observation group was patients with cervical spondylosis conforming to the diagnostic criteria, including cervical spondylosis of neck type, cervical spondylosis radiculopathy, cervical spondylotic myelopathy, cervical spondylosis of vertebral artery type, and sympathetic cervical spondylosis. According to MRI images of cervical spine, the structure of GV14 acupoint including skin, superficial fascia layer and aponeurosis ligament layer were measured. The acupoint depth and the superficial fascia thickness at GV14 in the observation group were (56.6±8.8) mm and (22.8±7.6) mm, the acupoint depth and the superficial fascia thickness at GV14 were (49.8±7.0) mm and (16.6±6.6)mm in the control group, which were significantly greater in the observation group than in the control group (P<0.01). The superficial fascia thickness at GV14 of cervical spondylotic mye-lopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy in the observation group was (23.8±8.1)mm, (23.0±7.3)mm and (22.6±6.5)mm, the acupoint depth of GV14 was (58.7±8.8)mm, (56.2±9.1)mm and (55.8±6.4)mm, which were significantly thicker than the superficial fascia thickness and the acupoint depth in the control group (P<0.01). In the observation group，the superficial fascia thickness of GV14 of cervical spondylosis myelopathy was significantly thicker than those of sympathetic cervical spondylosis (17.8±8.1) mm and cervical spondylosis of vertebral artery type (19.9±5.9) mm (P<0.01, P<0.05). In the observation group, the depth of GV14 of cervical spondylosis myelopathy was thicker than that of cervical spondylosis of neck type, cervical spondylosis radiculopathy, sympathetic cervical spondylosis and cervical spondylosis of vertebral artery type(P<0.05，P<0.01)； the depth of GV14 of sympathetic cervical spondylosis was thinner than that of cervical spondylosis of neck type and cervical spondylosis radiculopathy (P<0.01). The superficial fascia thickness at GV14 was correlated with cervical spondylosis, and it is also related to cervical spondylotic myelopathy, cervical spondylosis of neck type and cervical spondylosis radiculopathy. The morphological and structural changes of GV14 in the state of cervical spondylosis were mainly the thickness of the superficial fascia.

Extension of decompression to C2 doesn’t affect the spinal sagittal parameters compared with standard open-door laminoplasty

We modified and extended laminoplasty to the upper cervical spine on patients with canal stenosis associated with upper cervical spinal ossified lesions. However, whether the extended decompression range of laminoplasty can cause further effects on cervical stability is rarely studied at present. A retrospective study to analyze the relationship between the surgical levels and cervical sagittal parameters effects was performed in patients with cervical spondylosis myelopathy who had undergone posterior cervical expansive open-door laminoplasty with/without extending to C2. In total, 64 patients were divided into 2 groups according to the surgical levels. Radiologic outcomes of occipito-cervical angle (C0-2 Cobb angle), CL C27 Cobb angle, cervical sagittal vertical alignment, T1-Slope (T1S), T1S minus CL (T1S-CL), spino-cranial angle and center of the sella turcica-C7 SVA (St-SVA) were evaluated on lateral X-rays of the cervical spine at pre-operation, post-operation, and 2-year follow-up. The patient's health-related quality of life was obtained including neck disability index, Japanese orthopaedic association scores, and visual analog scale. Changes in sagittal parameters were observed in both groups after surgery. T1S, cervical sagittal vertical alignment, and T1S-CL significantly increased and CL decreased in 2 groups of patients postoperative. After a 2-year follow-up period, the C0-2 Cobb angle was found to increase compared to preoperative records. In addition, there were no significant differences in spino-cranial angle and st-SVA between preoperative and 2 years follow-up measurements. Health-related quality of life was improved in both groups and was not significantly different. Herein, the parameters indicated a tilting forward of the lower cervical spine and a more lordotic upper cervical spine to maintain a horizontal gaze in patients. However, C2 to 7 laminoplasty was performed to achieve satisfactory clinical results without significantly changing the spinal sagittal parameters.

Success Rate and Complications Associated with the Surgical Treatment of Cervical Spondylosis Myelopathy in Albania.

Background: Patients suffering from cervical spondylotic myelopathy (SCM) and that do not respond to conservative treatment could benefit from anterior cervical spine surgery. However, surgical intervention is associated with increased risk of complications and therefore the decision to operate should be weighed against benefits. The purpose of this study was to describe the effectiveness and the rate of complications of anterior cervical spine surgery among CSM who do not respond to conservative treatment in Albania.   &#x0D; Material and Methods: A total of 100 CSM patients who did not respond to conservative treatment and who showed up at our Service during 2014-2019 were subjected to anterior cervical spine surgery to resolve the CSM related signs and symptoms. The success rate as well as short-term and long-term complication of surgery were evaluated and reported.    &#x0D; Results: The mean age of CSM patients (59% males) in the study was 51.5 years. One surgical procedure was employed in 90% of CSM patients whereas two procedures were necessary in the remaining 10%. The overall success rate of anterior cervical spine surgery was 70% (excellent in 40% of CSM patients and good in 30% of patients) whereas in 30% of CSM patients’ surgery did not bring any benefit or there were no changes compared to before the surgery. The overall rate of complications was 16%; no patients died following surgery. Specific complications were rare and varying from 1% of patients (Brown-Sequard syndrome, vocal cord paresis, wound infection) to 3% (subcutaneous hematoma).&#x0D; Conclusion: Anterior cervical spine surgery is associated with a relatively high success rate and a low level of post-operative complications and it might be regarded as a safe treatment among these CSM patients who do not respond to conservative treatment.

Analysis of time-space variations during dynamic cervical spine motion in cervical spondylosis myelopathy patients

BACKGROUND CONTEXTDecreased cervical range of motion (ROM) is a common symptom of myelopathy patients. Many previous studies have relied on a variety of experimental approaches for quantifying static cervical range of motion. However, the change rules of time-space variation during dynamic cervical spine motion remains unknown. PURPOSETo develop and validate the effectiveness of a novel wearable robot-based sensor system, Analysis of Dynamic Cervical spine Motion (ADCM), in evaluating the dynamic cervical spine motion dysfunction of patients with cervical spondylotic myelopathy (CSM). STUDY DESIGN/SETTINGA cross-sectional study. PATIENT SAMPLEOne hundred forty consecutive healthy individuals (70 men and 70 women) and 120 CSM patients (60 men and 60 women) were enrolled in the present study. OUTCOME MEASURESThe cervical motion process parameters, including the flexion and extension ROM, the flexion and extension time, and the Japanese Orthopedic Association scores (JOA) for cervical spine were measured. METHODSTwo hundred and sixty consecutive participants were asked to wear ADCM system and then fully flex and extend their neck rapidly and evenly at tolerable maximum speed. The cervical motion process was recorded and converted into waveforms. Relevant waveform parameters were measured and analyzed. The number of complete flexion-extension motions in 10 seconds has been defined as 10s F–E cycles. The Japanese Orthopedics Association (JOA) scores of CSM patients were marked. RESULTSCSM patients had a lower number of 10s F–E cycles than healthy subjects. There were significant differences in flexion and extension time and ROM between two groups. The waveforms of myelopathy patients were wider and lower than those in healthy individuals. The average ratio value (defined as F) of wave height to wave width (a+b/c+d) could quantitatively reflect such differences of waveforms. The average F value was correlated with the JOA scores of the cervical motion function (r=0.7538), and F value declined as JOA scores decreased. According to receiver operating characteristic curve analysis, the optimal threshold value of the normal average ratio was more than 34.7. CONCLUSIONSADCM appears to be an objective and quantitative severity assessment tool for confirmed CSM patients by evaluating dynamic cervical spine motion dysfunction.

Investigation of Titanium Mesh and Nano-Hydroxyapatite/Polyamide 66 Bone Graft in Cervical Reconstruction of Spondylosis After Sub-Total Vertebral Body Resection

The nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bionic bone column, as a high-performance tissue repair and replacement material, introduced as a high osteo-induction ability agent. Nanomaterial has significantly taken a place in orthopedic surgery, however, the efficacy of using n-HA/PA66 is yet to be established. In this regard, this study evaluated various sagittal parameters (such as imaging measurement) and clinical efficacy in postoperative patients, whom underwent cervical reconstruction surgery due to cervical spondylosis myelopathy (CSM). In this study, total 62 CSM cases were enrolled between October 2016 to March 2020, and were hospitalized for cervical reconstruction surgery. 31 cases were grafted with titanium mesh and 31 cases were grafted with n-HA/P66. The sagittal parameters such as cervical spine lateral radiographs (C0-2Coob, C2-7Coob, T1S, CSVA, and TIA) were taken before operation, after operation (within 1 week), 3, 6, and 9 months after operation. In order to evaluate the clinical efficacy, we used JOA scores before, after, 3 months, 6 months and 9 months after operation. Results showed that JOA scores after the re-examination in the two groups (titanium and n-HA/P66) were significantly higher than before the operation, suggesting a well postoperative functional recovery after surgery in both groups; however, there was no significant difference in JOA score and JOA improvement index between the two groups. In regard of angles measurement (C0-2Cobb, C2-7Cobb, T1S, CSVA, and TIA), we observed no significant difference between these two groups before and after the operation. In addition, we showed that C0-2Cobb and C2-7Cobb angle had a significant positive correlation; and C0-2Cobb angle is positively correlated with T1S, and negatively correlated with CSVA. Both titanium mesh and n-HA/PA66 can be well improved and maintained within 9 months after surgery with clinical efficacy, however, using n-HA/PA66 might have more benefits.

Expression of AIF and Caspase-3 in New Zealand rabbit with Cervical Spondylosis Myelopathy model

IntroductionCervical spondylosis myelopathy (CSM) is a clinical syndrome of motoric or sensoric, caused by degenerative process chronically causing narrowing of cervical canal and compressing the spinal cord. The narrowing of canalis spinalis causing chronic compression and disrupting vascular patency in spinal cord. This is worsened on repetitive trauma on flexion, extension and rotation. CSM has an incidence of 4.04 in 100.000 cases per year and the total patients undergoing treatment operative or nonoperatively in year increasing for 7 times. Apoptosis plays a critical role in important biological processes such as morphogenesis, tissue homeostasis, and immunity; furthermore, its aberrant activation or impairment may contribute to a number of diseases. The understanding of CSM pathophysiology from apoptotic pathway is an essential topic to discussed and the treatment of this case in future. MethodThis study uses experimental study with Post test Only Control Group, using New Zealand rabbits. The rabbits given the compression on cervical as high as C5 to induce CSM. The tissue was taken from spinal cord on compression area and histopathology examination was done to calculate apoptotic factor expression such as AIF and caspase-3. ResultChronic compression on spinal cord causing myelopathy clinically on animal study, resulted in weakness of all extremities. Based on this study, the expression of AIF and caspase-3 is increasing in compression group in day 14 to day 21. ConclusionChronic compression in spinal cord causing increase in AIF and caspase-3 in day 14 and day 21, and this may be caused by increasing of apoptotic expression on animal study.

Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters

BackgroundFor patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters.MethodsA retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0–2 Cobb angle, C1–2 Cobb angle, C2–7 Cobb angle, C2–7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function.ResultsThe C0–2 and C1–2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2–7 Cobb angle (P = 0.001), C2–7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2–7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0–2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2–7 SVA was negatively correlated with the C2–7 Cobb angle (Pearson = − 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23.ConclusionsThe sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.

P120. The efficacy and safety of applying ultrasonic osteotome in cervical expansive open-door laminoplasty

BACKGROUND CONTEXT Ultrasonic osteotome is a tissue-specific device which offers potential advantages of more precise bone resection, reduced soft-tissue injury, and less demand in surgical skill, and have been used widely in spinal surgery. Yet few studies have investigated its safety and efficacy until now. PURPOSE To investigate the safety and efficacy of applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty. STUDY DESIGN/SETTING Retrospectiviely we collected the patients' clinical data and the follow-up image. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and underwent cervical expansive open-door laminoplasty. Then we divided these patients into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. PATIENT SAMPLE From March 2015 to March 2016, 94 consecutive patients who were administrated in the spine group of orthopedic department of Peking University Third Hospital were reviewed retrospectiviely. OUTCOME MEASURES Comparison was made between the traditional method using bone rongeur or high-speed grinding, and the piezosurgery group. Duration of operation (from skin incision to closure), blood loss during surgery, volume of drainage first day after operation, remaining of drainage tube, and occurrence of cerebrospinal fluid leak were assessed between the two groups. JOA spinal cord function scoring system (17-point method) was adopted to evaluation neurological function. JOA score before operation, 3 months after operation, 12 months after operation and JOA improvement rate was compared between two groups. JOA improvement rate = (postoperative JOA score - preoperative JOA score) / (17 - preoperative JOA score) × 100%. Three months and 12 months follow-up CT scans were used to evaluate portal shaft healing by assessing C4, C5, and C6 portal bones. METHODS From March 2015 to March 2016, 94 consecutive patients who were administrated in the spine group of orthopedic department of Peking University Third Hospital were reviewed retrospectiviely. All the patients were diagnosed as multilevel cervical spondylosis myelopathy and were underwent cervical expansive open-door laminoplasty. These patients were divided into two groups: ultrasonic osteotome group and traditional group, by whether the ultrasonic osteotome device was used in operation. The parameters we studied were as follows: the duration of operation, blood loss in operation, volume of drainage at the first postoperative day, days of remaining the drainage tube, preoperative and postoperative JOA score, complication of cerebrospinal fluid leak and hinge bone nonunion. RESULTS Comparing to the traditional group, the duration of operation of the ultrasonic osteotome group was increased, but the blood loss in operation, volume of drainage at the first postoperative day and days of remaining the drainage tube of the ultrasonic osteotome group were all reduced. There is no obvious difference between the two groups when considering the cerebrospinal fluid leak. At the 3 month follow-up, the JOA score and improvement rate of JOA score showed no obvious difference between the two groups. But the hinge bone union of the traditional group is better than the ultrasonic osteotome group. At the 12 month follow-up, all the JOA score, the improvement rate of JOA score and the hinge bone union were not obviously different between the two groups. CONCLUSIONS Applying ultrasonic osteotome in patients undergoing cervical expansive open-door laminoplasty is both safe and effective. Comparing with the rongeur, ultrasonic osteotome caused the delayed union of the hinge bone, but it reduces the blood loss in operation, volume of postoperative drainage and days of remaining the drainage tube. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Clinical outcome of cervical spondylosis myelopathy in preoperative and postoperative period

In clinical practice of neurological spine surgery it is necessary to explain the prognosis to the patients will empower patients if he or she ready subjecting himself to a surgery. It has to be answered in a scientific way based on studies done. This work study the clinical prognosis in clinical features in the pre and post-operative period taking the pre and post-operative symptoms and signs into consideration in cases of cervical myelopathy with spondylotic changes. We had analyzed 40 patients using the JOA (Japanese Orthopaedic Association score). We evaluated the clinical signs and symptoms of cervical spondylotic myelopathy in patient at pre and post-operative stage for a span of 3 months with the help of JOA. Cervico-spondylo-myelopathy were confirmed by neurological examinations and imaging studies (X-ray, CT and MRI). All patients underwent anterior cervical discectomy with titanium cage fusion. A JOA score of 12 or more was considered as normal.in our study. All our patients had various types of outcome in clinical features and a significant improvement was found in all the patients after 4 weeks of surgery. All underwent a single technique of cervical discectomy with cylindrical titanium cage fusion. No mortality was noted and majority of the patients had a better outcome with a score of >12. Any gross improvement can be expected only after 4 weeks and the surgical technique has a very low morbidity and mortality rate.

Pathological changes of cervical spinal canal in cervical spondylotic myelopathy: A retrospective study on 39 cases

Objective: To evaluate and compare the cervical spinal canal (CSC) morphology among healthy people, cervical spondylosis myelopathy (CSM), and latent cervical spondylosis (LCS, people with cervical spine degeneration on medical imaging but without clinic symptoms). Patients and Methods: We reviewed MRI data describing cervical spinal morphology in healthy persons, LSC patients and CSM patients. All cases underwent cervical MRI. In transverse image, anteroposterior diameter (A–P diameter), area of cervical spinal canal (CSC) and area of cervical spinal cord were measured. In sagittal image, A–P diameter was measured. Dural sac area = the area of CSC in the transverse position – the area of cervical spinal cord in transverse position. Results: There’re 8 cases in the healthy group, 18 cases in the group of LCS, and 13 cases in CSM group. Generally, the measured indicators at two ends of CSC (C2/3 and C7) are larger than those at C3–C6. A–P diameters on axial and sagittal position show a decrease trend from healthy group to LCS group and to CSM group. CSC area and dural sac area on axial position of CSM group are significantly lower than those in healthy group and LCS group. Almost all measured indicators of CSM group are significantly lower than healthy group and LCS group. Every two measured indicators in each group are significantly corelated. Conclusions: The results suggested that CSC size of CSM was smaller than that of LCS, and A–P diameter <11 mm, CSC area <170mm2 and dural sac area <90 mm2 were more advisable to indicate cervical spinal canal stenosis in Chinese people.

Functional outcome of posterior laminectomy in case of cervical myelopathy with multilevel cervical cord compression

Objective: The primary objective is to study the functional outcome of cervical laminectomy with or without instrumentation for cervical myelopathy in case of multilevel cervical cord compression using modified JOA and NURICK score.Introduction: Cervical myelopathy is a neurological pathology associated with a degenerative disease of the cervical spine resulting from a spinal cord compression. Cervical myelopathy presents with clinical implications in the upper and/or lower limbs caused by compression of the spinal cord. Loss of coordination, weakness and tactile sensitivity are some of the most common symptoms. Several procedures are available for the operative management of multi-level cervical spondylosis myelopathy or radiculopathy. Laminectomy has proven to be successful, but several inherent risks have been recognized. Postoperative instability and deformity, in particular kyphosis, is a well-documented problem.Methodology: A prospective and retrospective cohort of 30 patients with cervical myelopathy with multilevel cord compression treated with posterior laminectomy between January 2016 to December 2017 were analysed for minimum of 1 year and final result were analysed with modified JOA and NURICK score.Results: Cervical laminectomy as posterior approach alone or with posterior stabilisation with fusion can be chosen in patients of cervical myelopathy with multilevel cervical cord compression to achieve adequate decompression with comparable functional outcome as ACDF or ACCF.

ASSESSMENT OF SPINAL CORD COMPRESSION IN PATIENTS WITH CERVICAL SPONDYLOSIS, A CLINICAL PROSPECTIVE STUDY OF 25 PATIENTS

Background: Cervical spondylosis myelopathy (CSM) is a common cause of disability in older persons. Because spondylosis is a universal finding as the patients aged. Objective: To assess the demographic and management of cervical spondylosis in a sample of Iraqi patients. Methods: This is a prospective clinical study, carried out over the period from January 2013 to December 2014, and included 25 patients with cervical spondylosis myeloradiculopathy referred for surgical intervention in Neurosurgical Department in the Al-Imamein Al-Kadhimein Medical City. General examination and full neurological assessment were performed, as well as relevant investigations, particularly; radiological assessments. All of the patients were subjected to surgery, with 17 patients (68%) were treated with laminectomy and foraminotomy, while the remaining 8 patients (32%) were treated with laminectomy only. Results: They were 14 males and 11 females, slightly affects males more than females, aged 38 to 82 years it is more common in 5th and 6th decades of life, and in rural than urban areas. Myeloradiculopathic features were the most common presenting ones with C5-C7, which were the most affected levels. General examination and full neurological assessment were performed, as well as relevant investigations, particularly; radiological assessments. All of the patients were subjected to surgery, with 17 patients (68%) were treated with laminectomy and foraminotomy, while the remaining 8 patients (32%) were treated with laminectomy only. More than half of the patients were showed slight improvement in their complaints, while significant improvement occurred in more than 28 % of patients. Despite that, 20% of patients showed no improvement in their symptomatology, however; no reported deterioration was noticed in the study. Conclusion: Myeloradiculopathic feature were the most common presenting features with C5-C7 was the most level affected. Laminectomy with foraminotomy was surgery of choice in tow third of patients, with remaining one third underwent laminectomy only. Keywords: Cervical spondylosis, spinal cord compression Citation: Jaizany AJA, Nema IS, Hassan YM. Assessment of spinal cord compression in patients with cervical spondylosis, a clinical prospective study of 25 patients. Iraqi JMS. 2018; 16(2): 152-158. doi: 10.22578/IJMS.16.2.6

Cortical Reorganizations for Recovery from Depressive State After Spinal Decompression Surgery.

Depressed mood following neuronal damage not only impedes functional recovery but also negatively affects quality of life for many patients. Depressed patients with cervical myelopathy often show improvement in both mood and motor function after spinal decompression surgery; however, the neural mechanism underlying this psychological benefit from surgery remains unclear. The aim of this study was to clarify the brain sites that relate to alleviation of depression after spinal decompression surgery. We compared brain activity of patients with cervical myelopathy (n= 6) with healthy participants (n=5) using functional magnetic resonance imaging. We then analyzed functional magnetic resonance imaging data to find the brain regions that correlated with depression severity (n= 12; 6 preoperative patients and 6 postoperative patients) and compared preoperative imaging data with postoperative imaging data from patients. Spinal decompression surgery alleviated depression and diminished anterior cingulate cortex activity. Simultaneously, supplementary motor area activity, which was increased in patients with myelopathy compared with control subjects, was diminished after surgery. Traditionally, surgical indications for myelopathy are determined by the severity of sensorimotor symptoms without considering psychological symptoms. We anticipate our results will lead to more informed surgical decisions for cervical spondylosis myelopathy.

Validity and responsiveness of the Simple Test for Evaluating Hand Function

Introduction Despite widespread use of the Simple Test for Evaluating Hand Function, we were unable to find studies to affirm the validity and responsiveness in patients with trauma and inflammatory diseases. The aim of this study was to demonstrate the criterion validity and responsiveness of the Simple Test for Evaluating Hand Function, a tool which is widely used in Japan. Methods Thirty patients between the ages of 20 and 82 years with distal radius fracture (n = 10), and cervical spondylosis myelopathy (n = 20) were included in this study. Concurrent validity was tested by examining the correlation between Simple Test for Evaluating Hand Function, the Purdue Pegboard Test, and the Disabilities of the Arm, Shoulder and Hand questionnaire. In addition, standardized response means were calculated to compare the responsiveness of the Simple Test for Evaluating Hand Function with Purdue Pegboard Test and Disabilities of the Arm, Shoulder and Hand. Results The correlation coefficient between Simple Test for Evaluating Hand Function and Purdue Pegboard Test was 0.70, and the correlation between Simple Test for Evaluating Hand Function and Disabilities of the Arm, Shoulder and Hand was −0.55 (p &lt; 0.05). Standardized response mean shows that the Simple Test for Evaluating Hand Function (0.69) is more responsive than the Purdue Pegboard Test (0.53), and less responsive than Disabilities of the Arm, Shoulder and Hand (0.97). Conclusions The Simple Test for Evaluating Hand Function demonstrates concurrent validity and responsiveness as a performance based assessment of dexterity in patients with distal radius fracture and cervical spondylosis. We conclude that the Simple Test for Evaluating Hand Function could be used as a measure of dexterity or clinical change after therapy intervention. The Purdue Pegboard Test may be used for patients with an occupation that requires integrated fine motor skills and bimanual activity, whereas the Simple Test for Evaluating Hand Function may be more suitable for patients who use a variety of unilateral grips such as pinch and span. The Simple Test for Evaluating Hand Function and Disabilities of the Arm, Shoulder and Hand can complement each other when measuring someone’s activity and participation level.

Effects of decompressive cervical surgery on blood pressure in cervical spondylosis patients with hypertension: a time series cohort study.

BackgroundPatients with cervical spondylosis myelopathy (CSM) and complicated with hypertension are often experiencing a blood pressure decrease after taking cervical decompressive surgery in clinical observations, but how this blood pressure reduction is associated with the surgery, which cut cervical sympathetic nervous, has never been rigorously assessed. Thus, the purpose of this study is to investigate the effect of cervical decompressive surgery on blood pressure among CSM patients with hypertension.Methods/DesignThe study will be a time series cohort study. Fifty eligible patients will be selected consecutively from the Peking University First Hospital. Two 24-h ambulatory blood pressure measurement (ABPM) will be taken before the surgery, apart by at least 3 days. The patients will be followed up for another two ABPMs at 1 and 3 months after the surgery.We will recruit subjects with cervical spondylosis myelopathy meeting operation indications and scheduled for receiving cervical decompressive surgery, aged 18–84 years, have a history of hypertension or office systolic blood pressure ≥140 mmHg on initial screening, and willing to participate in the study and provide informed consent. Exclusion criteria includes a history of known secondary hypertension, visual analogue scale (VAS) score ≥4, and unable to comply with study due to severe psychosis.The change in systolic ABPs over the four times will be analyzed to observe the overall pattern of the blood pressure change in relation to the surgery, but the primary analysis will be the comparison of systolic ABP between the 2nd and 3rd , 4th measurements (before and after the surgery). We will also calculate the regression-to-the-mean adjusted changes in systolic ABP as sensitivity analysis. Secondary endpoints are the changes in 24 h ABPM diastolic blood pressure, blood pressure control status, the use and dose adjustment of antihypertensive medication, and the incidence of operative complications. Primary outcome analyses will be carried out using analysis of covariance, as well as the first secondary endpoint.DiscussionThis study will inform us the important knowledge about cervical sympathetic nervous system (SNS) and blood pressure. Once confirmed, it may help to produce new method for control of hypertension, which is the leading cause of death in the world.Trial registrationThe study is registered to Clinical Trials.gov (NCT02016768).

Physical therapy for a patient with cervical spondylosis myelopathy with the complication of degenerative spondylosis who experienced difficulty performing an activity with both hands while standing

Physical therapy for a patient with cervical spondylosis myelopathy with the complication of degenerative spondylosis who experienced difficulty performing an activity with both hands while standing

Clinical Use of the Nanohydroxyapatite/Polyamide Mesh Cage in Anterior Cervical Corpectomy and Fusion Surgery

Purpose. This study was to report the clinical use of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA 66) mesh cages in anterior cervical corpectomy and fusion (ACCF) surgery.Method. 95 patients who underwent single level anterior cervical corpectomy and fusion for cervical spondylosis myelopathy (CSM) in our hospital were reviewed and divided into 2 groups according to using nanohydroxyapatite/polyamide mesh cage and titanium mesh cage (TMC). Demographic data of patients and surgical, clinical, and radiological data before operation and at last follow-up were collected and compared.Result. The operation time, surgical blood loss, complications, and Japanese Orthopaedic Association scores (JOA scores) of two groups were similar. At the last follow-up both the two groups obtained 100% solid bone fusion, but the TMC group had higher rate of severe cage subsidence than the n-HA/PA 66 group (27% versus 2%).Conclusion. Nanohydroxyapatite/polyamide 66 mesh cage is safe and effective in ACCF and can be a substitution to titanium mesh cage.