Management Of Cervical Myelopathy Research Articles

AYURVEDIC MANAGEMENT OF CERVICAL MYELOPATHY- A CASE REPORT

Introduction: Cervical Myelopathy is a neurological impairment caused by compression of the cervical spinal cord mostly due to degenerative cervical spondylosis. Axial imaging is the modality for diagnosis which shows myelomalacia and focal cord atrophy. Main clinical findings:A58 years old female with complaints of weakness of both legs since 6 months which aggravated past 2 months, associated with numbness of both soles and palms came to OPD of our hospital. Diagnosis: She was diagnosed and treated for cervical myelopathy. Depending on the clinical signs and symptoms of the patient the condition can be correlated to Khalli (Kaphavrutha vyana and raktavritavata). Intervention:The patient was managed with internal and external medications including ksharavasthi. Outcome: The treatment showed marked improvement in gait, pain, numbness in both extremities and urinary incontinence. Conclusion: This article is an attempt to shed light on the management of cervical myelopathy and to explore the scope of further study

The value of dynamic MRI in cervical spondylotic myelopathy: About 24 cases.

Dynamic magnetic resonance imaging (MRI) of the cervical spine is extremely useful in assessing pathological changes at the spinal cord, vertebrae, discs, ligaments and facet joints. We attempted to document the radiological changes that the cervical spine undergoes during dynamic maneuvers and the effects of Dynamic MRI in management of cervical myelopathy, emphasizing on the changes in treatment protocol effected by the new findings discovered. Our work is based on 24 consecutive patients with cervical spondylotic myelopathy had cervical MR imaging in neutral position, in flexion and extension of the cervical spine between January 2021 and December 2021. The result found the mean age was 57.9 years (range 26-85 years). Among these 24 patients, there were 11 males and 13 females. Total number of levels of compression were 47 and the additional levels of involvement were 17. Additional levels of compression were noted in 12 patients, among these 17 new levels, 7 were in the posterior and 10 in the anterior. The most affected level was C5C6 with 16 cases. All additional levels of compression were noted in extension; Reduction of the cervical canal was observed in 20 patients only in extension. In the bending sequences we have noticed an increase of the canal diameter in 3 patients. The location of the compression is in 15 cases anterior, 2 cases posterior and 5 cases are mixed anterior and posterior Surgery was considered in 17 patients. Anterior procedures were 11 (ACDF/corpectomy and fusion) and Posterior surgeries were 6 (laminoplasty/laminectomy), and. The rest of the patients did not require surgery and was conservatively treated. A change of the signal was found in 3 patients during the acquisition in extension position a. Most studies have shown a reduction of the root canal with an increase of the compression level, which was the case in our study. MRI is a useful tool for diagnosis of CM, it does not give an exact idea as to which is the offending level in a multilevel compression that requires surgery. Even the approach and procedure cannot be decided on a static examination and hence are subject to significant interpractitioner the role of extension MRI in determining cervical compression levels. Thus, dynamic cervical spine MRI should be an important investigation before we decide to write off surgical treatment in patients with cervical myelopathy and cord signal changes without definitive compression on static MRI. Flexion and extension MRI is an important tool for decision making and planning appropriate management in cervical compressive myelopathy.

Surgical management of continuous and mixed type of OPLL in cervical spine: Experience in tertiary level hospital.

Background: Ossification of the posterior longitudinal ligament (OPLL) is a chronically progressive disease of ectopic enchondral and membranous ossification of posterior longitudinal ligament (PLL). Controversy still persists over the superiority of various surgical approaches for cervical OPLL management. Purpose: To see the efficacy of expansive laminoplasty for the management of continuous and mixed type of cervical OPLL retrospectively. Methods: Records of 20 male and 8 female aged 36-72 years (mean, 56.64 years), who underwent surgical treatment posteriorly for continuous and mixed type OPLL by laminoplasty were obtained from the year 2004 - 2020. Clinical features along with imaging studies, which included X -ray/CT /MRI, were done for the diagnosis of OPLL. Multiple variables were studied, including demographics, surgical parameters, complications and functional outcomes. Results: They were followed on an average of 59.86 ± 20.95 months (range, 24 -108 months). The average operative duration was 95 ± 15.52 min (range: 70 - 140), and the intraoperative blood loss was 199.29 ± 33.55 ml. The cervical curvature index reduced to 8.81 ± 1.96 from 11.00 ± 2.49 and the VAS score decreased from 4.25 ± 0.75 to 2.43 ± 1.40. mJOA score improved from 8.64 ± 1.03 to 13.96 ± 1.26 on the last follow-up after surgery (p < 0.01), with average recovery rate of 65.5 %. Conclusions: The management for cervical myelopathy with multilevel stenosis due to continuous and mixed type of OPLL by Laminoplasty is safe and effective.

Cervical Myelopathy: An Update on Posterior Decompression.

This was a narrative review. The aim was to discuss current methods and review updated outcome studies regarding posterior decompression in the management of cervical myelopathy. Progressive myelopathy in the cervical segments is an indication for urgent surgical management. Although nonoperative treatment is an option in mild to moderate cases, the majority of patients will experience deterioration in neurological function requiring surgical decompression. A review of the literature was performed using PubMed to provide updated information regarding posterior cervical decompression in the management of myelopathy. There are numerous studies comparing outcome data between cervical laminectomy and fusion with laminoplasty. While each technique has advantages and disadvantages, both provide adequate decompression and good long-term outcomes in patients meeting appropriate criteria. Posterior decompression is an important approach for spine surgeons to have in their toolkits when treating cervical myelopathy.

45. Trajectory of change in mJOA score within one year following surgery for degenerative cervical myelopathy

BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The natural progression of DCM is variable; some patients experience periods of stability, while others rapidly deteriorate following disease onset. The majority of these patients require surgical decompression to halt disease progression and improve functionality. The modified Japanese Orthopedic Association (mJOA) is a patient-reported questionnaire commonly used to grade symptoms and is a validated tool for assessment of postoperative improvement in the surgical management of cervical myelopathy. However, literature describing the natural history of recovery following surgical decompression is limited, especially in the postsurgical period of 3 to 12 months. PURPOSE The aim of the study is to assess the trajectory of mJOA improvement in the postsurgical period of 3 to 12 months in patients who underwent surgery for cervical myelopathy. STUDY DESIGN/SETTING This study is a retrospective analysis of prospectively collected data from the cervical module of a national spine registry, the Quality Outcomes Database (QOD). PATIENT SAMPLE A total of 2,156 patients who underwent elective surgery for DCM and had complete 3- and 12-month follow-up data in the QOD registry were included in the study. OUTCOME MEASURES The mJOA score was used to define severity of myelopathic symptoms in patients who underwent surgery for cervical myelopathy. METHODS Patients were divided into mild (≥14), moderate (9-13), or severe ( RESULTS Patients improved significantly from baseline to 3 months on their mJOA scores, regardless of their baseline mJOA severity. Four hundred five (18.8%) showed improvement during the time period of 3- to 12-month postsurgical follow-up. After adjusting for the relevant baseline patient and surgery specific characteristics, the baseline mJOA categories had significant impact on whether a patient improves by 2 points in mJOA score from 3- to 12-month postsurgery (75.49% of the total Wald X2, p CONCLUSIONS In the surgical management of cervical myelopathy, most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep improving until after a longer follow-up. Preoperative identification of such patients helps the clinician with setting realistic expectations for each follow-up time point. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

275. The effect of the distal level or proximal level on post-laminoplasty loss of cervical vertebra lordosis

BACKGROUND CONTEXT Open-door laminoplasty is a useful operation in the surgical management of cervical myelopathy with favorable outcomes and relatively low complications. One potential undesirable outcome is a decrease in cervical lordosis postoperatively. It is unknown whether the most the distal level or proximal level undergoing laminoplasty affects the magnitude of loss of lordosis. PURPOSE This study aimed to compare the loss of cervical lordosis postoperatively in patients for whom the most proximal level undergoing laminoplasty is proximal level. STUDY DESIGN/SETTING A retrospective radiographic review as a center was carried out. PATIENT SAMPLE A total of 513 patients at a single institution who underwent plated open door laminoplasty for cervical myelopathy by multiple surgeons over a 5-year period were included. OUTCOME MEASURES The primary outcome was change in cervical lordosis, which was the difference in C2-T1 Cobb angle between the postoperative and preoperative film. METHODS Patients were divided into two groups based on the most proximal vertebral level undergoing laminoplasty. There were 157 patients who underwent laminoplasty beginning at C2, whereas 171 patients underwent laminoplasty beginning at C3, whereas 137 patients underwent laminoplasty beginning at C4, whereas 48 patients underwent laminoplasty beginning at C5. The C2-T1 Cobb angle was measured on the preoperative film and on the final postoperative follow-up film. The difference between these values was calculated for each patient, and the mean of the differences for the C3 group was compared with that of the C4 group. RESULTS When C2 was the proximal plated laminoplasty level, loss of lordosis averaged 12°. When C3 was the proximal plated laminoplasty level, loss of lordosis averaged 10°. When C4 was the proximal plated laminoplasty level, loss of lordosis averaged 4°. In contrast, when C5 was the proximal plated level, loss of lordosis was significantly less and averaged only 2° (p=0.041). In the group as a whole, mean preoperative lordosis was 21° compared with 12° postoperatively, for an overall 8° loss of lordosis. CONCLUSIONS Starting the laminoplasty at C4 led to significantly less loss of lordosis than starting at C2-C3. When the pattern of spinal cord compression does not require laminoplasty at C3, consideration should be given to making C4 the most cephalad laminoplasty level rather than C3 to better preserve lordosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The most influential publications in cervical myelopathy.

Management of cervical myelopathy (CM) has continued to evolve through a better understanding of the long-term outcomes of this diagnosis as well as improved diagnostic guidelines. More recent literature continues to expand the field, but certain publications can be distinguished from others due to their lasting impact. Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to CM. The fifty most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level of evidence (LOE), article type, as well as contributing authors and institutions were recorded. We also highlighted the five most cited articles (per year) from the past 10 years. Publications included ranged from 1952-2011, with the plurality of articles published during 2000-2009 (n=21; 42%). The most cited paper was Hillibrand's 1999 reporting of adjacent segment disease rates following cervical fusions, followed by Hirabayashi's 1983 review of his cervical laminoplasty outcomes. The third most cited was Brain's 1952 review of the manifestations of cervical spondylosis. Spine contributed the most publications (n=26; 52%). A LOE of III was the most common (n=30; 60%). Clinical outcome articles were the most frequent type (n=28; 56%). Osaka University (Japan) and Kazou Yonenobu had the most contributions. Ames or Fehlings were the first or last author in each of the five most influential articles from the past 10 years. This bibliometric citation analysis identifies the most influential articles regarding CM. There are few publications with a high LOE, and more high powered studies are needed. Knowledge of these "classic" publications allows for a better overall understanding of the diagnosis, treatment, and future direction of research of CM.

A novel technique to practice using a high-speed burr for spinal anterior cervical discectomy and fusion.

Background:Anterior cervical discectomy and fusion has been a successful procedure in terms of patient satisfaction in the management of cervical myelopathy and radiculopathy. The procedure involves an anterior approach to the cervical vertebral column and decompression of the neural elements.Aim:A key part of the procedure is the removal of the posterior osteophyte. This is usually performed using a high-speed burr. In inexperienced hands, this part of the procedure can be a challenging one.Materials:Egg, egg cup, zinc oxide tape and high-speed burr.Conclusion:We describe a simple and cost effective method of practicing this manoeuver, enabling the trainee to gain sufficient confidence in handling the tool around delicate tissues.

Surgical Management of Cervical Myelopathy: An Analysis of Patient Characteristics, Surgical Procedures, Complication Rates and Risk Factors

Surgical Management of Cervical Myelopathy: An Analysis of Patient Characteristics, Surgical Procedures, Complication Rates and Risk Factors

Surgically treated cervical myelopathy: a functional outcome comparison study between multilevel anterior cervical decompression fusion with instrumentation and posterior laminoplasty

Background contextMultilevel cervical myelopathy can be treated with anterior cervical discectomy and fusion (ACDF) or corpectomy via the anterior approach and laminoplasty via the posterior approach. Till date, there is no proven superior approach. PurposeTo elucidate any potential advantage of one approach over the other with regard to clinical midterm outcomes in this study. Study designA prospective, 2-year follow-up of patients with cervical myelopathy treated with multilevel anterior cervical decompression fusion and plating and posterior laminoplasty. Patient sampleIn total, 116 patients were studied. Sixty-four patients underwent ACDF two levels and above or anterior cervical corpectomy and fusion one level and above. Fifty-two patients underwent posterior cervical surgery (laminoplasty C3–C6 and C3–C7). Outcome measuresSelf-report measures: Japan Orthopedic Association (JOA) score, JOA recovery rate, visual analog scale for neck pain (VASNP), neck disability index (NDI), and American Academy of Orthopaedic Surgeons (AAOS) neurogenic symptom score (AAOS-NSS). Physiologic measures: range of motion (ROM) flexion and extension of neck. Functional measures: short-form 36 (SF-36) score comprising physical functioning, physical role function, bodily pain, general health, vitality, social role function, emotional role function, and mental health scales. MethodsComparison of the JOA scores, JOA recovery rates, NDI scores, SF-36 scores, VASNP, and ROM preoperatively to 2 years. Chi-square and two-sided Student t tests were used to analyze the variables. ResultsPosterior surgery took an hour shorter (p<.05) and had better improvement in JOA scores at early follow-up of 6 months (p=.025). Anterior surgery group had better improvement of NDI scores at early follow-up of 6 months (p=.024) and was associated with less blood loss intraoperatively compared with posterior surgery. There was no statistical difference between the two groups for JOA scores, JOA recovery rates, SF-36 quality-of-life scores, NDI, AAOS-NSS, VAS neck pain, and ROM at 2 years. Complications were higher for anterior surgery group: two hematoma postoperation, one vocal cord paresis, and one new onset C6/C7 dermatome numbness versus one dura leak in posterior surgery group. ConclusionsOur study showed that patients with multilevel disease treated with laminoplasty do well and compare favorably with patients treated with an anterior approach. Notably, posterior surgery was associated with shorter operating time, better improvement in JOA scores at 6 months, and a tendency toward lesser complications. Posterior surgery was not associated with increased neck disability and neck pain at 2 years. Anterior surgery had better NDI improvement at early follow-up. There is a need for a larger study that is prospectively randomized with long-term follow-up before we can confidently advocate one approach over the other in the management of cervical myelopathy.

Steroids have no place in the management of cervical myelopathy

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults in Western society. Very little has been written about it in Nigeria. This would give the impression that it is rare in Nigeria. Unfortunately, this is not the case and having seen a few patients now in Abuja, we can appreciate some of the real issues. Patients with cervical spondylotic myelopathy are not being properly diagnosed and managed. It is often thought to be a disease of old age and part of life. Others feel that old age and infirmity preclude management and so patients are not referred to hospital. Families also at times prefer local management with traditional healers. Finally, patients are often treated only by general practitioners, general medicine physicians and neurologists. We have now seen a few patients who have been treated long term for CSM by neurologists without referral for surgical intervention. Patients having been seen are placed on long term steroid therapy, vitamin C and analgesics and neuropathic pain medicines such as Carbamazepine, Gabapentin and Pregabalin. Our perspective is that such treatment especially for moderate or severe CSM is of little benefit to address the fundamental and underlying problem in CSM. In our opinion, steroid use is not necessary and predisposes patients to diabetes, osteoporosis and avascular necrosis of the head of femur. The other two key problems in the past were poor availability of MRI scans and spine trained neurosurgeons.

DORSAL SURGERY FOR MYELOPATHY AND MYELORADICULOPATHY

To review the dorsal approaches to the cervical spine for myelopathy and myeloradiculopathy. The literature was reviewed in reference to dorsal approaches for cervical myelopathy and myeloradiculopathy. There are a variety of surgical approaches in the management of cervical myelopathy and myeloradiculopathy. Deciding which is the best method for any individual requires the surgeon to be aware of the advantages of each technique, as well as the complications and limitations of each approach. Laminectomy is the traditional technique used for multilevel cervical stenosis. The complications related to laminectomy, such as late neurological decline, kyphosis, instability, and postoperative radiculopathy, led to laminectomy with fusion. In Japan, dissatisfaction with both laminectomy and laminectomy with fusion led to the development of laminoplasty for dorsal treatment of multilevel cervical stenosis. This article highlights the salient features of preoperative evaluation in this patient population as it pertains to dorsal surgical approaches. Additionally, the techniques of laminectomy, laminectomy with fusion, and laminoplasty are compared, and the results are reviewed.