Cervical Myelopathy Evaluation Research Articles

351 Diffusion and Cerebrospinal Fluid Flow Magnetic Resonance Imaging in the Evaluation of Cervical Stenosis and Myelopathy

Abstract INTRODUCTION Diffusion-weighted imaging (DWI) may be more sensitive in detecting early cervical cord injury than abnormal T2-signal. Cerebrospinal fluid (CSF) flow studies may demonstrate degree of stenosis based on cervical cord motion. This study evaluates tests correlation of DWI and cord motion to myelopathy severity and degree of stenosis. METHODS Prospectively, adult patients with concern for cervical stenosis underwent cervical magnetic resonance imaging (MRI) (T2, Cine CSF Flow, and DWI). Images were reviewed neuroradiologists blinded to the patient's clinical condition. Correlation of MRI findings to neurological status and outcomes following surgery were evaluated. RESULTS >Twenty patients were enrolled. Mean age was 66 years, and 40% were male. Eleven presented with myelopathy and 9 had pain, weakness, and/or sensory changes. All patients had radiographic cervical stenosis (14 severe, 5 moderate, and 1 mild). In the presence of cervical stenosis, paradoxical cord motion (moving opposite to the rest of cord) was observed in 79% of severe and 50% of mild/moderate stenosis. The sensitivities of MRI findings to detect clinical myelopathy were 63% for T2 signal, 73% for abnormal DWI, 73% for abnormal cord motion, 91% for abnormal DWI/cord motion, and 100% for abnormal T2/DWI/cord motion. Fourteen patients underwent surgical decompression (4 anterior and 10 posterior). Ten of those 14 patients had improved Nurick myelopathy score. Of the 4 patients who did not improve, their MRI profile revealed that all preoperative MRI had abnormal cord motion (2 with normal T2-signal and DWI) (P = 0.126). Among the 6 patients (1 moderate and 5 severe stenosis) who did not undergo surgery, 1 worsened (abnormal T2-signal/DWI/cord motion) while 5 others had no change in neurological status. CONCLUSION DWI and CSF flow studies are sensitive modalities in detecting myelopathy and evaluating cervical stenosis severity. Abnormal DWI and cord motion are present in myelopathic patients without T2-signal abnormality and maybe useful prognostic indicators.

Endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations

Objective To introduce the surgical techniques of image⁃guided endoscopic transnasal odontoidectomy to treat basilar invagination with congenital osseous malformations and describe several advantages compared to the traditional transoral procedure. Methods From September 2009 to February 2010, two cases with basilar invagination, of which the etiology was congenital osseous malformations, underwent endoscopic transnasal odontoidectomy. Case 2 also received occipitocervical fixation and bone fusion during the same surgical episode to ensure stability. The clinical symptoms of the two cases were evaluated by using the Japanese Orthopaedic Association (JOA) score for the evaluation of cervical myelopathy. Results Both patients were extubated after recovery from anesthesia and allowed oral food intake the next day. Cerebrospinal fluid rhinorrhea was found in the second case and cured by continuous lumber drainage of cerebrospinal fluid. No infection was noted. The average follow⁃up time was more than 24 months. Remarkable neurological recovery was observed at postoperation in both patients. The JOA scores elevated from preoperative 12 and 8 to postoperative 17 and 15. Conclusion The endoscopic transnasal odontoidectomy is a more minimally invasive approach for anterior decompression of cervicomedullary with basilar invagination. The advantages over the standard transoral odontoidectomy include visualization improvement, elimination of risk of tongue swelling and teeth damaging, alleviation of prolonged intubation, reduction of need for enteral tube feeding, and less risk of affecting phonation. DOI：10.3969/j.issn.1672⁃6731.2012.04.012

S7-2 Electrophysiological evaluation of cervical spondylotic radiculopathy and myelopathy

S7-2 Electrophysiological evaluation of cervical spondylotic radiculopathy and myelopathy

Evaluation of five scoring systems for cervical spondylogenic myelopathy

Background contextComparison of measured clinical deficits and outcomes is vital for international discussion about the identification and treatment of cervical spondylotic myelopathy (CSM). There is currently little information comparing outcomes as assessed by different CSM scoring systems. PurposeTo qualitatively and quantitatively analyze five specific CSM outcome scores that are frequently used to assess the grade of severity and outcome after operative decompression. Study designThis retrospective study evaluated the Nurick score, the Japanese Orthopedic Association score (JOA score), the Cooper myelopathy scale (CMS), the Prolo score, and the European myelopathy score (EMS). Patient sampleThe study included 43 patients with clinical and morphological signs of CSM, who underwent ventral decompression. Data were evaluated in sufficient detail to objectively assess the scores. Outcome measuresClinical findings (funicular and radicular symptoms), recovery rate, symptom duration, age, economic situation, time away from employment, somatic-evoked potentials, and radiological findings were assessed. MethodsScores were assessed using both pre- and postoperative clinical data. Correlations between scores, score improvement, and how well the scores reflected the clinical, diagnostic, and anamnestic data were analyzed using nonparametric, descriptive statistical tests. The recovery rate, as a measure of cumulative outcome, was also assessed and compared for each scoring system. ResultsAll five scores were suitable for qualitatively assessing the clinical characteristics and progression of cervical myelopathy. All showed a statistically significant correlation (p<.05), and measured postoperative improvement (p<.001). All scores also reflected clinical deficits except for the Prolo score, which rates the severity of CSM with an emphasis on data related to the economic impact on the patient's situation rather than on clinical symptoms per se. Quantitative assessment of clinical symptom improvement varied greatly among the scores, for example, Nurick score (33%) versus JOA score (81%). The recovery rates, as a measure of cumulative improvement, showed less variation among most of the scores. The Nurick score and the EMS measured clinical deficit improvements in significantly fewer patients than did the JOA score (p<.05). ConclusionsEvaluating the recovery rate is essential for comparing the results of the five CSM scores evaluated in this study. There was a large quantitative difference among the scores as the result of the different criteria used to produce each score. Qualitatively, all five scores allowed evaluation of cervical myelopathy, but only the recovery rate allowed for statistical comparison. Advancements in the treatment of CSM depend on the ability of clinicians to evaluate the therapeutic results of CSM studies. This study suggests that using the recovery rate to assess outcome is best for comparing studies that use different scores.

Cervical Compressive Myelopathy Evaluation with MTR Magnetic Resonance Technique

Cervical Compressive Myelopathy Evaluation with MTR Magnetic Resonance Technique

Evaluation of cervical myelopathy with stabilometry

Evaluation of cervical myelopathy with stabilometry

Motor and somatosensory evoked potentials in the evaluation of cervical spondylytic myelopathy

Motor and somatosensory evoked potentials in the evaluation of cervical spondylytic myelopathy

頚椎症性脊髄症の治療成績判定基準について 問題点と提案

In this report, we proposed an amended evaluation system of cervical spondylotic myelopathy, to discuss (consider) problems of the score system of the Japanese Orthopaedic Association.The main Points are as follows.1) The total score is 100 points: 30 points for the function of up-per limbs, 30 for the function of lower limbs, 20 for sensory, and 20 for the function of the bladdar.2) Sensory and mortor functions of extremities and estimated on either side.3) The ability of the gait is estimated to be divided into 11 classes, from impossibility of the gait to normal gait.4) The function of the upper limb is estimated to be diveded into 3 parts; shoulder, elbow and finger.