Diagnosis Of Cervical Spondylotic Myelopathy Research Articles

Diffusion Tensor Tractography in Patient with Cervical Spondylosis and Correlation with Clinical Findings

Introduction: Diffusion tensor imaging is a non-invasive advanced method that provides information on white matter microstructural integrity. Fractional anisotropy and apparent diffusion coefficient have been used to quantify the degree of axonal damage and demyelination. The study aims to assess the role of diffusion tensor parameters in detecting early myelopathic changes and correlate them with clinical findings. Methods: This cross-sectional prospective study including 60 patients with clinical history of cervical myelopathy was carried out at the Department of Radiology from June 2021 to July 2022. Nurick score was used to assess the severity clinically and diffusion tensor images of the cervical spine were obtained using 3 Tesla MRI. These diffusion tensor values at the level of maximum stenosis were compared with those of the non-stenotic level. A correlation between the diffusion tensor parameters and clinical Nurick score was done. Results: The fractional anisotropy values were significantly lower (0.51 ± 0.14 vs 0.76 ± 0.47) and apparent diffusion coefficient values were significantly higher (1.20 ± 0.20 vs 1.04 ± 0.12) at the level of maximum stenosis compared with non-stenotic levels. There was a moderate positive and strong negative correlation between the apparent diffusion coefficient and fractional anisotropy values with the Nurick score. Conclusions: A significant reduction in the fractional anisotropy and an increase in apparent diffusion coefficient values at the level of stenosis was observed in individuals without a high T2 signal within the cord. Thus, these parameters might have a potential role in the early diagnosis of cervical spondylotic myelopathy

Cervical Spondylotic Myelopathy-Diagnostics and Clinimetrics.

Cervical myelopathy is referred to in many ways in the English literature, for example, as cervical spondylotic myelopathy (CSM), spondylotic radiculomyelopathy (SRM) or degenerative cervical myelopathy (DCM). In addition, more frequent occurrences are noted in older adults and to a greater extent in men. The causes of the effects of cervical myelopathy may be the appearance of lesions on the spinal cord, ischemia due to compression of the vertebral artery and repeated micro-injuries during maximal movements-hyperflexion or hyperextension. It is well known that lesions on the spinal cord may occur in a quarter of the population, and this problem is clearly noted in people over 60 years old. The symptoms of SCM develop insidiously, and their severity and side (unilateral or bilateral) are associated with the location and extent of spinal cord compression. Neurological examination most often diagnoses problems in the upper limbs (most often paresis with developing hand muscle atrophy), pyramidal paralysis in one or both lower limbs and disorders in the urinary system. To make a diagnosis of CSM, it is necessary to perform MRI and neurophysiological tests (such as EMG or sensory and/or motor-evoked potentials). The use of appropriately selected scales and specific tests in diagnostics is also crucial. This narrative review article describes the latest knowledge on the diagnosis and clinimetrics of cervical spondylotic myelopathy in adults and provides future directions.

Role of MRI Diffusion Tensor Imaging in early diagnosis of Cervical Spondylotic Myelopathy (CSM)

Role of MRI Diffusion Tensor Imaging in early diagnosis of Cervical Spondylotic Myelopathy (CSM)

Aided diagnosis of cervical spondylotic myelopathy using deep learning methods based on electroencephalography

Cervical spondylotic myelopathy (CSM) is the most severe type of cervical spondylosis. It is challenging to achieve early diagnosis with current clinical diagnostic tools. In this paper, we propose an end-to-end deep learning approach for early diagnosis of CSM. Electroencephalography (EEG) experiments were conducted with patients having spinal cord cervical spondylosis and age-matched normal subjects. A Convolutional Neural Network with Long Short-Term Memory Networks (CNN-LSTM) model was employed for the classification of patients versus normal individuals. In contrast, a Convolutional Neural Network with Bidirectional Long Short-Term Memory Networks and attention mechanism (CNN-BiLSTM-attention) model was used to classify regular, mild, and severe patients. The models were trained using focal Loss instead of traditional cross-entropy Loss, and cross-validation was performed. Our method achieved a classification accuracy of 92.5 % for the two-class classification among 40 subjects and 72.2 % for the three-class classification among 36 subjects. Furthermore, we observed that the proposed model outperformed traditional EEG decoding models. This paper presents an effective computer-aided diagnosis method that eliminates the need for manual extraction of EEG features and holds potential for future auxiliary diagnosis of spinal cord-type cervical spondylosis.

Diagnostic value of magnetic resonance diffusion tensor imaging in evaluation of cervical spondylotic myelopathy

BackgroundRadiological diagnosis of cervical spondylotic myelopathy should be made as early as possible to obtain favourable clinical outcomes when compared with later stages. Diffusion tensor imaging can reveal early structural changes of the cord in patients with cervical compressive myelopathy.AimThis study aimed to assess the role of magnetic resonance diffusion tensor imaging in the accurate evaluation of cervical spondylotic myelopathy.Patients and methodsThis prospective study included a group of 60 patients with neurological symptoms suggestive for cervical spondylotic myelopathy and a control group of 30 healthy subjects. The clinical severity of compressive myelopathy was assessed based on the European myelopathy score. Magnetic resonance diffusion tensor imaging and tractography were done for all patients and controls.ResultsFractional anisotropy values at the most compressed segments of spinal cord are lower while apparent diffusion coefficient values of the same segments are higher than healthy segments in controls. Fractional anisotropy and apparent diffusion coefficient parameters had higher sensitivity (97.0% and 88.1%, respectively) than conventional T2 WIs (13.4%) and fibre tractography (10%) for the detection of early compressive myelopathy with cutoff values ≤ 0.56 and > 1.23, respectively, in differentiating between patients and control groups.ConclusionDiffusion tensor imaging indices are valuable tools for quantitative assessment of degenerative cervical spondylotic myelopathy in addition to routine cervical spine magnetic resonance.

Role of MRI Diffusion Tensor Imaging in Early Diagnosis of Cervical Spondylotic Myelopathy (CSM)

Abstract Background and Purpose Cervical spondylotic myelopathy (CSM) is a common degenerative disorder of the cervical spine and is considered as the most common cause of spinal cord dysfunction in older individuals worldwide. Assessing the severity of the disease objectively remains a challenge and there is still remaining controversy in terms of the optimal timing and indications for surgical intervention. The conventional MRI is the gold standard for radiographic evaluation of the spinal cord; however, it cannot assess the underlying microstructural deficits of the spinal cord and it has a limited application in determining prognosis and recovery of the disease [1]. We sought to assess the utility of MR diffusion tensor imaging as an imaging technique in clinically suggested CSM patients by obtaining the microstructural parameters (Fractional anisotropy; FA and apparent diffusion coefficient; ADC) in the cervical spinal cord segments. Patient & methods our study was a prospective cross-sectional study including 40 patients with clinical manifestations of cervical spondylotic myelopathy. The patients were sorted according to the European myelopathy score into three categories as follows: grade 1 (with mild symptoms), grade 2 (with moderate symptoms) and grade 3 (with severe symptoms). All the patients were investigated with a 1.5 T MRI unit acquiring conventional MRI and DTI sequences. FA and ADC values at each spinal segment from C2/C3 to C6/C7 were generated and measured using manual drawing of multiple ROIs within the cervical cord in the sagittal and axial combined anatomical and color-coded images. For each of these cases, the patient’s age, gender, DTI parameters at each spinal segment level, maximum compression level, conventional T2WI characteristics and EMS score were recorded, analyzed and compared. Results The study included 23 females (57.5%) and 17 males (42.5%). Their age ranged from 30 to 72 years with a mean age of 47.3 ± 9.79 years. The study revealed a significant difference in the mean FA and ADC values between stenotic and non-stenotic segments of the cervical spinal cord. There was a significant correlation between the European myelopathy score and DTI parameters (FA and ADC). FA and ADC values performed better in recognizing myelopathic changes in patients who were classified as grade 1 according to EMS compared to conventional MRI T2WI which performed very poorly in recognizing myelopathy changes in the same patients, therefore DTI indices were more sensitive in the detection of CSM patients compared to conventional MRI especially in early myelopathic stages. T2 weighted images were highly significant in recognizing myelopathy changes in patients who were classified as grade 3 according to EMS. The CSM patients had significant FA decrease and ADC increase at the most compressed part of the cervical spinal cord and there was a significant correlation between the number of patients who had myelopathic changes by DTI parameters and the severity of disease. The FA sensitivity and specificity in recognition of myelopathic changes were 73.5% and 83.3% respectively and the ADC sensitivity and specificity were 100% and 70.6% respectively. Conclusion In conclusion, diffusion tensor imaging enhances the efficacy and accuracy of MRI in the diagnosis of cervical spondylotic myelopathy. Therefore, it can be used as a non-invasive modality for detection of the spondylotic myelopathy changes in the early stages helping to decide the appropriate timing of decompression surgery before attaining the irreversible chronic changes. Abbreviations ADC: Apparent diffusion coefficient; CSM: Cervical spondylotic myelopathy; DTI: Diffusion tensor imaging; FA: Fractional Anisotropy; EMS: European myelopathy score

Machine learning-based detection of cervical spondylotic myelopathy using multiple gait parameters

Cervical spondylotic myelopathy (CSM) is the main cause of adult spinal cord dysfunction, mostly appearing in middle-aged and elderly patients. Currently, the diagnosis of this condition depends mainly on the available imaging tools such as X-ray, computed tomography and magnetic resonance imaging (MRI), of which MRI is the gold standard for clinical diagnosis. However, MRI data cannot clearly demonstrate the dynamic characteristics of CSM, and the overall process is far from cost-efficient. Therefore, this study proposes a new method using multiple gait parameters and shallow classifiers to dynamically detect the occurrence of CSM. In the present study, 45 patients with CSM and 45 age-matched asymptomatic healthy controls (HCs) were recruited, and a three-dimensional (3D) motion capture system was utilized to capture the locomotion data. Furthermore, 63 spatiotemporal, kinematic, and nonlinear parameters were extracted, including lower limb joint angles in the sagittal, coronal, and transverse planes. Then, the Shapley Additive exPlanations (SHAP) value was utilized for feature selection and reduction of the dimensionality of features, and five traditional shallow classifiers, including support vector machine (SVM), logistic regression (LR), k-nearest neighbor (KNN), decision tree (DT), and random forest (RF), were used to classify gait patterns between CSM patients and HCs. On the basis of the 10-fold cross-validation method, the highest average accuracy was achieved by SVM (95.56%). Our results demonstrated that the proposed method could effectively detect CSM and thus serve as an automated auxiliary tool for the clinical diagnosis of CSM.

Quantitative evaluation of the spinal cord compression in patients with cervical spondylotic myelopathy using synthetic MRI.

Objectives: This work aimed to investigate the feasibility and diagnostic value of synthetic MRI, including T1, T2 and PD values in determining the severity of cervical spondylotic myelopathy (CSM). Methods: All subjects (51 CSM patients and 9 healthy controls) underwent synthetic MRI scan on a 3.0TGEMR scanner. The cervical canal stenosis degree of subjects was graded 0-III based on the method of a MRI grading system. Regions of interest (ROIs) were manually drawn at the maximal compression level (MCL) by covering the whole spinal cord to generate T1MCL, T2MCL, and PDMCL values in grade I-III groups. Besides, anteroposterior (AP) and transverse (Trans) diameters of the spinal cord at MCL were measured in grade II and grade III groups, and relative values were calculated as follows: rAP = APMCL/APnormal, rTrans = TransMCL/Transnormal. rMIN = rAP/rTrans. Results: T1MCL value showed a decreasing trend with severity of grades (from grade 0 to grade II, p < 0.05), while it increased dramatically at grade III. T2MCL value showed no significant difference among grade groups (from grade 0 to grade II), while it increased dramatically at grade III compared to grade II (p < 0.05). PDMCL value showed no statistical difference among all grade groups. rMIN of grade III was significantly lower than that of grade II (p < 0.05). T2MCL value was negatively correlated with rMIN, whereas positively correlated with rTrans. Conclusion: Synthetic MRI can provide not only multiple contrast images but also quantitative mapping, which is showed promisingly to be a reliable and efficient method in the quantitative diagnosis of CSM.

SOMATO-SENSORY EVOKED POTENTIAL AS A PROGNOSTIC MARKER IN CERVICAL SPONDYLOTIC MYELOPATHY.

Objective: Methods: To study the use SSEP for predicting surgical outcome of cervical myelopathy.Goals of the study. Cervical spondylosis is a common cause of cervical myelopathy in patients over the age of 50, and its incidence increases with age. Clinical signs and radiological ndings aid in the diagnosis of cervical spondylotic myelopathy. In some cases where clinical presentations are unclear, neurophysiological investigations such as somatosensory-evoked potentials (SSEPs) may be useful for establishing a clinical diagnosis. However, the prognostic value of these investigations is not well-established Single center, retrospective study wherein forty nine patients (mean age of participants was 39.63 years with standard deviation ± 5.75) who had cervical spine surgery for cervical spondylotic myelopathy with documented preoperative time required for somatosensory-evoked potentials (SSEP) were followed for 12 weeks postoperatively. We evaluated the N17 time, P19 time for right and left median nerve and P47 time of right and left tibial nerve and compared it with the MJOA score recovery rate for each period. Methods used to achieve the study goals. It was found that improvement in the SSEP during the e Result: arly decompression period and a good surgical outcome at 12 weeks postoperatively was signicant statistically. Somatosensory e Conclusion: voked potential of median nerve is useful in determining the functional abnormality of the spinal cord. Results/ndings of the study. Conclusions dra Results: Conclusions: wn from the work. Abstracts for reviews, technical notes, and historical vignettes do not need to be separated into sections. They should begin with a clear statement of the paper's purpose followed by appropriate details that support the authors' conclusion(s).

High reliability and accuracy of dynamic magnetic resonance imaging in the diagnosis of cervical Spondylotic myelopathy: a multicenter study

BackgroundCervical spondylotic myelopathy (CSM) is a critical condition that results in significant neurologic deterioration. An accurate diagnosis is essential for determining its outcome and prognosis. The pathology is strongly associated with dynamic factors; therefore, dynamic magnetic resonance (MR) image could be crucial to accurately detect CSM. However, very few studies have evaluated the reliability and accuracy of dynamic MR in CSM. In this study, we aimed to compare intra- and interobserver reliabilities and accuracy of dynamic MR in detecting CSM using sagittal MR scans of the neck in the flexed, neutral, and extended position.MethodsOut of 131 patients who underwent surgical treatments for CSM, 107 were enrolled in this study. The patient underwent three-types of sagittal MR scans that were obtained separately in different neck positions (neutral, flexion, and extension postures). The MR scans of the cervical spine were evaluated independently by three spine professionals, on the basis of tabled questionnaires. For accuracy, we performed a receiver operator characteristic analysis, and the overall discriminating ability of each method was measured by calculating the area under the ROC curve. The Cohen’s kappa coefficient and the Fleiss-generalized kappa coefficient was used to the inter- and intra-observer reliabilities.ResultsThe intraobserver reliability (using the Cohen’s kappa coefficient) and interobserver reliability (using the Fless kappa coefficient) were respectively 0.64 and 0.52 for the neutral sagittal MR. The accuracy of neutral sagittal MR in detecting CSM was 0.735 (95% CI, 0.720 to 0.741) while that of extension sagittal MRI was 0.932 (96% CI, 0.921 to 0.948).ConclusionsDynamic MR significantly showed better diagnostic reliability and accuracy in detecting CSM compared to conventional MR. In particular, extension MR scans could provide a more accurate diagnosis than other images.

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The purpose of this case study was to describe the diagnosis of cervical spondylotic myelopathy through telemedicine during the COVID-19 pandemic.A 57-year-old male patient was evaluated at a Veterans Affairs chiropractic clinic via video telemedicine for evaluation regarding neck pain and bilateral arm paresthesia.During the initial evaluation performed by video telemedicine, the doctor of chiropractic was concerned about the possibility of cervical spondylotic myelopathy. This prompted a face-to-face consultation with the patient for further evaluation. The face-to-face evaluation revealed correlating objective findings, including brisk reflexes and transient clonus. Noncontrast magnetic resonance imaging of the cervical spine was performed, which showed evidence of cord compression with associated myelomalacia in the cervical spine at the C4-C5 level. After a neurosurgical consultation, the patient underwent successful anterior cervical decompression and fusion at the C4-C5 level.Chiropractic services through live video telemedicine in conjunction with face-to-face evaluation resulted in a timely neurosurgical consultation and successful decompression of the affected region. In this case, telemedicine facilitated a positive outcome for a patient with cervical spondylotic myelopathy.

Deep learning algorithm to evaluate cervical spondylotic myelopathy using lateral cervical spine radiograph

BackgroundDeep learning (DL) is an advanced machine learning approach used in different areas such as image analysis, bioinformatics, and natural language processing. A convolutional neural network (CNN) is a representative DL model that is highly advantageous for imaging recognition and classification This study aimed to develop a CNN using lateral cervical spine radiograph to detect cervical spondylotic myelopathy (CSM).MethodsWe retrospectively recruited 207 patients who visited the spine center of a university hospital. Of them, 96 had CSM (CSM patients) while 111 did not have CSM (non-CSM patients). CNN algorithm was used to detect cervical spondylotic myelopathy. Of the included patients, 70% (145 images) were assigned randomly to the training set, while the remaining 30% (62 images) to the test set to measure the model performance.ResultsThe accuracy of detecting CSM was 87.1%, and the area under the curve was 0.864 (95% CI, 0.780-0.949).ConclusionThe CNN model using the lateral cervical spine radiographs of each patient could be helpful in the diagnosis of CSM.

Geographic variations in health care resource utilization following elective ACDF for cervical spondylotic myelopathy: A national trend analysis

BackgroundAs health care expenditures continue to increase, standardizing health care delivery across geographic regions has been identified as a method to reduce costs. However, few studies have demonstrated how the practice of elective spine surgery varies by geographic location. The aim of this study was to assess the geographic variations in management, complications, and total cost of elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). MethodsThe National Inpatient Sample database (2016-2017) was queried using the ICD-10-CM procedural and diagnostic coding systems to identify all adult (≥18 years) patients with a primary diagnosis of CSM undergoing an elective ACDF. Patients were divided into regional cohorts as defined by the U.S. Census Bureau: Northeast, Midwest, South, and West. Weighted patient demographics, Elixhauser comorbidities, perioperative complications, length of stay (LOS), discharge disposition, and total cost of admission were assessed. ResultsA total of 17,385 adult patients were identified. While the age (p=0.116) and proportion of female patients (p=0.447) were similar among the cohorts, race (p<0.001) and healthcare coverage (p<0.001) varied significantly. The Northeast had the largest proportion of patients in the 76-100th household income quartile (Northeast: 32.1%; Midwest: 16.9%; South: 15.7%; West: 27.5%, p<0.001). Complication rates were similar between regional cohorts (Northeast: 10.1%; Midwest: 12.2%; South: 10.3%; West: 11.9%, p=0.503), as was LOS (Northeast: 2.2±2.4 days; Midwest: 2.1±2.4 days; South: 2.0±2.5 days; West: 2.1±2.4 days, p=0.678). The West incurred the greatest mean total cost of admission (Northeast: $19,167±10,267; Midwest: $18,903±9,114; South: $18,566±10,152; West: $24,322±15,126, p<0.001). The Northeast had the lowest proportion of patients with a routine discharge (Northeast: 72.0%; Midwest: 84.8%; South: 82.3%; West: 83.3%, p<0.001). The odds ratio for Western hospital region was 3.46 [95% CI: (2.41, 4.96), p<0.001] compared to the Northeast for increased cost. ConclusionOur study suggests that regional variations exist in elective ACDF for CSM, including patient demographics, hospital costs, and nonroutine discharges, while complication rates and LOS were similar between regions.

228. Complications following posterior cervical arthrodesis for cervical spondylotic myelopathy: a single institution's experience

<h3>BACKGROUND CONTEXT</h3> Posterior cervical fusion (PCF) is a frequently performed surgery for treatment of cervical spondylotic myelopathy (CSM). While incidences of these risks have been reported previously, prior studies on this topic either contain small sample sizes, pooled from multiple institutional or public databases, or have low follow-up duration. Here, we report the incidence of postoperative complications following PCF for CSM at a single institution with a large patient cohort. To review the rate of postoperative complications following primary posterior cervical fusion for cervical CSM at a single institution. <h3>PURPOSE</h3> To review the rate of postoperative complications following primary posterior cervical fusion for CSM at a single institution. <h3>STUDY DESIGN/SETTING</h3> Retrospective case series, single institution. <h3>METHODS</h3> Patients with a diagnosis of CSM treated with PCF over a 4-year period at a tertiary care center were identified. Exclusion criteria included: (1) cervical myelopathy secondary to trauma, spinal infection, or spinal neoplasm, (2) fusion constructs that proximally included occiput or C1, or distally extended below T2, and (3) revision PCF procedures. Postoperative data collected included incidence of superficial surgical site infection (SSI), deep wound infection, subsequent irrigation and debridement (I&D), postoperative pneumonia, venous thromboembolism (VTE), epidural hematoma, and C5 nerve palsy during course of follow-up. Multivariable regression analyses were performed to identify patient characteristics and comorbidities that were independent risk factors for these complications. <h3>RESULTS</h3> A total of 176 patients met inclusion criteria (mean age + standard deviation = 63.8 + 11.1 years). An average of four levels (range: 1-7) were fused per surgery. Mean follow-up was one year. Of 176 patients, 33 (18.7%) had at least one documented postoperative complication. There were six cases (3.4%) of superficial SSI and four cases (2.3%) of deep wound infection. One patient (0.57%) developed a postoperative epidural hematoma. There were five cases (2.8%) of VTE and six cases (3.4%) of postoperative pneumonia. Fifteen patients (8.5%) developed C5 nerve palsy, of which 12 of 15 cases were transient and improved. Diabetes was an independent risk factor for postoperative VTE (p=0.03) and pneumonia (p=0.03). <h3>CONCLUSIONS</h3> Almost 1 in 6 patients had some complication after posterior cervical fusion for treatment of CSM. The incidence of C5 nerve palsy at 8.5% was not trivial. Though PCF is a routine procedure, our results highlight the need for appropriate preoperative counseling, especially in patients with diabetes mellitus. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Independent Association of Obesity and Nonroutine Discharge Disposition After Elective Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy

The prevalence of obesity continues to rise in the United States at a disparaging rate. Although previous studies have attempted to identify the influence obesity has on short-term outcomes following elective spine surgery, few studies have assessed the impact on discharge disposition following anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). The aim of this study was to determine whether obesity impacts the hospital management, cost, and discharge disposition after elective ACDF for adult CSM. The National Inpatient Sample database was queried using the International Classification of Diseases, 10th revision, Clinical Modification, coding system to identify all (≥18 years) patients with a primary diagnosis of CSM undergoing an elective ACDF for the years 2016 and 2017. Discharge weights were used to estimate national demographics, Elixhauser comorbidities, complications, length of stay, total cost of admission, and discharge disposition. There were 17,385 patients included in the study, of whom 3035 (17.4%) had obesity (no obesity: 14,350; obesity: 3035). The cohort with obesity had a significantly greater proportion of patients with 3 or more comorbidities compared with the cohort with no obesity (no obesity: 28.1% vs. obesity: 43.5%, P < 0.001). The overall complication rates were greater in the cohort with obesity (no obesity: 10.3% vs. obesity: 14.3%, P= 0.003). On average, the cohort with obesity incurred a total cost of admission $1154 greater than the cost of the cohort with no obesity (no obesity: $19,732 ± 11,605 vs. obesity: $20,886 ± 10,883, P= 0.034) and a significantly greater proportion of nonroutine discharges (no obesity: 16.6% vs. obesity: 24.2%, P < 0.001). In multivariate regression analysis, obesity, age, race, health care coverage, hospital bed size, region, comorbidity, and complication rates all were independently associated with nonroutine discharge disposition. Our study demonstrates that obesity is an independent predictor for nonroutine discharge disposition following elective anterior cervical discectomy and fusion for cervical spondylotic myelopathy.

Role of diffusion tensor imaging (DTI) as a quantitative diagnostic tool in assessing cervical spondylotic myelopathy

Aims and Objectives: To compare fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values obtained by DTI in stenotic and non-stenotic cervical spinal segments of patients with clinical evidence of cervical spondylotic myelopathy. Materials and Methods: A prospective study was conducted among 50 individuals over a period of 18 months. MRI of cervical spine was performed in patients referred/admitted to the institution with clinical suspicion of cervical spondylotic myelopathy. The protocol included: 2D sagittal T1WI, T2WI, STIR sequence, axial T2WI, T1WI, coronal STIR sequence and axial DTI sequences. Post-processing was done using Philips FIBRETRAK software. Results: In the study there was significant decrease in the values of FA at the levels with canal stenosis and a FA cut-off value ≤0.459 had sensitivity of 100% and specificity of 85.6% for diagnosing cervical spondylotic myelopathy. Similarly, there was a significant increase in the ADC value at the stenotic levels and the cut-off value >1.3265 x 10-3 mm2/s had a sensitivity of 100% and a specificity of 76%. Conclusions and Recommendations: DTI can thus be used as an efficient tool in early diagnosis of cervical spondylotic myelopathy in patients where there are no obvious changes in the signal intensity of the cord.

Cervical spondylotic myelopathy: Association of MRI changes and outcome predictors after surgical intervention

Introduction: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older individuals. Controversy remains in terms of the optimal timing and indications for surgical intervention. In this context, it would be of benefit to define clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention for CSM. Material and Methods: This was a prospective and observational study conducted in the Department of Radio diagnosis, Subbaiah Institute of Medical Sciences, Shimoga. All patients with functional disability secondary to cervical degenerative myelopathy and radiculopathy underwent surgery for decompression of the spinal cord with or without spinal stabilization from January 2020 to September 2020 were studied. A diagnosis of CSM required radiological confirmation (MRI) and at least one or more “upper motor neuron” findings (spasticity, hyper-reflexia, clonus and positive Babinski sign). Result: Among group A patients, 7 patients (77.7%) have improved postoperatively when compared according to Nurick grading. 9 patients (60%) have improved postoperatively. Among group C patients, only 2 patient (33.3%) have improved and majority (66.6%) remained in same grade as per Nurick grading. Conclusions: MR techniques play an indispensable role in the management of CSM patients and have evolved primarily from a diagnostic modality to a method that can potentially predict patient outcome following surgical intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for CSM

24. Cervical spine steroid injections for delay of surgery for cervical spondylotic myelopathy

BACKGROUND CONTEXT Cervical spine steroid injections are increasingly being used for diagnosis and treatment of degenerative pathology. For cervical spondylotic myelopathy traditionally treated with surgery, there has been little investigation of the possible therapeutic or preventive effects of targeted injections. As injections may be targeted to the epidural space, the transforaminal region, or the zygapophyseal joints, differing injection modalities may also have variable therapeutic effects. PURPOSE To determine the potential for cervical spine steroid injections to delay surgical treatment for cervical spondylotic myelopathy. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 39,590 patients with a new diagnosis of cervical spondylotic myelopathy, without previous cervical spine surgery. OUTCOME MEASURES Timing of surgical treatment (cervical decompression, fusion, or arthroplasty, from anterior or posterior approaches). METHODS Administration of cervical epidural, transforaminal, or zygapophyseal steroid injections was determined based on Current Procedural Terminology (CPT) codes. Timing of surgical treatment (cervical decompression, fusion, or arthroplasty, from anterior or posterior approaches) was also determined based on CPT codes. Multivariate logistic regression was used to determine the association of steroid injection administration with surgical treatment at various time points after initial diagnosis (1, 3, 6 months, and 1, 2, 5 years). RESULTS A total of 39,590 patients with a new diagnosis of cervical spondylotic myelopathy were identified. A total of 6,405 patients (16.2%) underwent cervical epidural steroid injections, 1,426 (3.6%) underwent transforaminal steroid injections, and 647 (1.6%) underwent zygapophyseal injections. Mean time from initial diagnosis to surgery was 180.2 days (standard deviation=345.9 days). In multivariate analysis epidural injections were associated with decreased odds of surgery within 1 month of diagnosis (odds ratio [OR]=0.69, P CONCLUSIONS Epidural steroid injections do not prevent surgical treatment of cervical spondylotic myelopathy in the long run. There may be some short-term symptomatic benefits that lead to delayed surgical treatment, although the clinical benefits have yet to be demonstrated. No significant benefit is seen with transforaminal or zygapophyseal injections for treatment of cervical myelopathy. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

31. A comparison of various surgical treatments for cervical spondylotic myelopathy: a propensity score matched analysis

BACKGROUND CONTEXT Several established options for the treatment of cervical spondylotic myelopathy (CSM) exist, but the ideal surgical technique remains elusive due to the lack of comprehensive comparative analyses. PURPOSE To examine the short-term outcomes between ACDF, laminectomy and fusion (LF), and laminoplasty (LP) for patients with CSM. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Adult patients with a primary diagnosis of CSM who underwent ACDF, LF, vs LP from 2016 to 2017. OUTCOME MEASURES Perioperative complications, readmissions, and reoperations. METHODS A prospectively-collected, multicentered national database with a propensity score matching to compare the short-term outcomes for LP, LF, and ACDF. Bivariate analyses involved both chi-square/Fisher exact test and t-tests on perioperative factors. Multivariate analyses were performed to determined independent risk factors for short term outcomes. RESULTS A total of 564 patients remained after propensity score matching, with 188 patients in each cohort. The any complication rate was highest in LF (11.2%) vs ACDF (4.3%) and LP (7.5%), p=0.066. LF group was more likely to undergo a reoperation within 30 days than LP patients (OR5, 4.3% vs 1.1%, p=0.042). Compared to ACDF, LP were more likely to have LOS>1 day (OR12, 88.3% vs 37.8%, p CONCLUSIONS LF is associated with the highest morbidity, readmission, and reoperation. Top reoperation reasons were wound complications and persistent myelopathic symptoms. LP had the lowest readmission rates; however, longer LOS than ACDF likely related to the longer operative time and greater proportion of patients requiring discharge to a skilled nursing facility. In early postop, LF carries the highest risk for complications requiring reoperation. LP is associated with longer LOS than ACDF without an increase in individual/overall complications, readmissions, and reoperations. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Associated risk factors for extended length of stay following anterior cervical discectomy and fusion for cervical spondylotic myelopathy

ObjectivesThere is a paucity of literature describing the predictors associated with extended length of hospital stay (LOS) for patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy. The aim of this study was to identify the patient- and hospital-level factors associated with extended LOS for patients with cervical spondylotic myelopathy undergoing ACDF. Patients and methodsThe National Inpatient Sample database was queried to identify patients with a diagnosis of cervical spondylotic myelopathy undergoing ACDF between 2010 and 2014. Updated trend weights were used to assess patient demographics, comorbidities, complications, LOS, discharge disposition and total cost. Multivariate logistic regression was used to determine the odds ratio for risk-adjusted LOS. The primary outcome was the degree to which patient comorbidities or postoperative complications correlated with extended LOS (>3 days). ResultsWe identified 144,514 patients with 29,947 (20.7%) experiencing an extended LOS (Normal LOS: 114,567; Extended LOS: 29,947). Comorbidities were overall significantly higher in the extended LOS cohort compared to the normal LOS cohort. Patients with extended LOS had a significantly greater proportion of blood transfusion (p < 0.001) and 2–3 vertebral levels fused (p < 0.001). The overall complication rates were greater in the extended LOS cohort (Normal LOS: 7.4% vs. Extended LOS: 44.8%, p < 0.001). The extended LOS cohort incurred $14,489 more in total cost (Normal LOS: $15,486 [11,787–20,623] vs. Extended LOS: $29,975 [21,286–45,285], p < 0.001) and had more patients discharged to non-routine locations (p < 0.001) compared to the normal LOS cohort. On multivariate logistic regression, several risk-factors were associated with extended LOS including: age, male gender, Black and Hispanic race, patient income, insurance, multiple comorbidities, blood transfusion, and number of complications. The odds ratio for extended LOS was 5.15 (95% CI: 4.68–5.67) for patients with 1 complication and 25.54 (95% CI: 20.54–31.75) for patients with >1 complication. ConclusionOur national cohort study demonstrated multiple patient- and hospital-level factors associated with extended LOS (>3 days) after ACDF for CSM. Specifically, patients with an extended LOS had lower socioeconomic status, higher rate of comorbidities, greater percentage of postoperative complications and non-routine discharges, with greater overall costs. Further investigational studies are necessary to identify quality improvement strategies targeted to better optimizing patients preoperatively and reducing perioperative complications in order to improve quality of patient care and reduce hospital LOS.