Management Of Cervical Spondylotic Myelopathy Research Articles

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 < 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 < A < H). Advanced age (>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.

Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database.

Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual's quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored. The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3. A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01). Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients' driving abilities at 24 months and hence patients' quality of life.

Impact of Educational Background on Preoperative Disease Severity and Postoperative Outcomes Among Patients With Cervical Spondylotic Myelopathy.

Retrospective review of a prospectively maintained database. Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM). Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care. The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms >3 or ≤3 months, and 24-month patient-reported outcome measures were evaluated. Among 1141 patients with CSM, 509 (44.6%) had an EL of high school or below, 471 (41.3%) had a graduate degree, and 161 (14.1%) had obtained postgraduate education. Lower EL was statistically significantly associated with symptom duration of >3 months (odds ratio=1.68), higher arm pain numeric rating scale (NRS) (coefficient=0.5), and higher neck pain NRS (coefficient=0.79). Patients with postgraduate education had statistically significantly lower Neck Disability Index (NDI) scores (coefficient=-7.17), lower arm pain scores (coefficient=-1), and higher quality-adjusted life-years (QALY) scores (coefficient=0.06). Twenty-four months after surgery, patients of lower EL had higher NDI scores, higher pain NRS scores, and lower QALY scores ( P <0.05 in all analyses). Among patients undergoing surgical management for CSM, those reporting a lower educational level tended to present with longer symptom duration, more disease-inflicted disability and pain, and lower QALY scores. As such, patients of a lower EL are a potentially vulnerable subpopulation, and their health literacy and access to care should be prioritized.

Comparison between 3-level and 4-level anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy: A meta-analysis

ObjectiveOur objective is to estimate the clinical effectiveness of 3-level and 4-level anterior cervical discectomy and fusion (ACDF) in the management of cervical spondylotic myelopathy (CSM). MethodsWe conducted a thorough search in English databases. We gathered the data on surgical variables and complications to contrast the clinical effectiveness between 3-level and 4-level. We utilized RevMan 5.3 and STATA 12.0 to analyze the data. ResultsFinally, eight studies met inclusion criteria of this study. Our findings indicated that operation time [p for heterogeneity = 0.23, I2 = 32 %, p＜0.00001, OR = −24.93, 95%CI (−32.39,-17.49)], blood loss [p for heterogeneity = 0.33, I2 = 10 %, p＜0.00001, OR = −60.87, 95%CI (−85.43,-36.32)] and the total number of complications [p for heterogeneity = 0.36, I2 = 0 %, p = 0.004, OR = 0.37, 95%CI (0.18,0.72)] in 3-level ACDF were significantly less than in 4-level ACDF. No marked difference was found in hospital stay, revision rate, fusion rate, the number of readmissions, infection, hematoma, or pseudarthrosis between 3-level and 4-level ACDF. ConclusionsIt is easy to understand that performing 4-level needs more operation time and blood loss. No obvious discrepancy was found with regard to the subgroups of complications between the two procedures, yet 4-level procedures had a more number of complications.

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

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

Exercise efficacy in management of Cervical Spondylotic Myelopathy – A case report

Cervical Spondylotic Myelopathy is an ageing, degenerative spinal condition and a common cause of myelopathy in adults, with the average age of presentation being 56 years. This case report was on a 63-year man who was apparently healthy until he was presented with grade v on Nurick Classification System for Myelopathy. Lhermitte Sign was present. The clinical presentations were motor deficit in the upper limbs (ULs), lower limbs (LLs) and hands; intermittent bouts of spasms in lower limbs; painfully reduced range of motion (ROM) in the shoulder, cervical and lumbosacral joints; impaired activity of daily living (ADL) including ambulation, and reduced sleeping hours. The treatment plan aimed to relieve pain at the affected joints; improve ROM in joints of ULs and LLs; strengthen weak muscles (ULs and LLs); improve trunk control; improve patella mobility and release of tight muscle/structures(hamstrings). The adopted Exercise protocols, which were done between 11 am-1 pm at thrice weekly appointments for four months, were Mobilization &amp; Strengthening Exercises (all limbs); Back Flexibility Exercises; Quadriceps Strengthening Exercises both LLs and Neuromotor Exercises. The patient became stable on a tripod stand in the fourth month and was discharged on a home programme at the end of the fourth month. The observed improvement in the clinical condition of this Cervical Spondylotic Myelopathy patient lays credence to the efficacy of the use of exercise interventions in this condition.

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

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

Comparative outcome analysis of lateral mass fixation and trans-facet fixation with posterior decompression in the management of cervical spondylotic myelopathy: An institutional experience.

Aims and ObjectivesPosterior subaxial cervical fusion with lateral mass screw and rod instrumentation is a well-established fixation technique. Subaxial transarticular facet fixation is a lesser known fusion technique that has been shown to be biomechanically equivalent to lateral mass screws. The aim of this study was to evaluate the outcome of cervical decompressive laminectomy with lateral mass fixation compared with decompressive laminectomy with trans-facet fixation.Materials and Methods:The study was conducted with 20 patients operated for cervical decompressive laminectomy with lateral mass fixation compared with 20 patients operated with trans-facet fixation. The modified Japanese orthopedic association score (mJOA) scale, Nurick's functional grading and neurological recovery rate (NRR) was used as the functional outcome measurement. The clinical follow-up period was 6 months.Results:In Group I, the mean preoperative and postoperative mJOA scores in Group I and II were 8.2 ± 2.1 and 12.7 ± 2.8 and 9.3 ± 1.9 and 13.5 ± 1.88, respectively, were statistically significant (P < 0.05). Postoperative NRR at the end of the follow-up period was satisfactory (excellent and good) 55% in Group I and 60% in Group II. Fusion was documented in all 40 patients. No patients experienced neural or vascular injury as a result of screw position.Conclusions:Both trans-facet and lateral mass fixation techniques are simple, safe, and effective procedures in achieving relief and improvement in patients with multilevel cervical spondylotic myelopathy. Trans-facetal fixation can provide a reasonable alternative to lateral mass fixation.

Full endoscopic anterior cervical discectomy and interbody fusion in patients with cervical spondylotic myelopathy

Background: For the surgical treatment of cervical spondylotic myelopathy (CSM), anterior decompression with fusion or posterior decompression using microscopy has been used widely as the standard procedure, depending on the location of pathology and the surgeon's preference. Endoscopic anterior cervical discectomy and interbody fusion (E-ACDF) is a minimally invasive, effective surgical option for the management of CSM. The advantages of using endoscopy for anterior cervical discectomy and interbody fusion (ACDF) are better visualization of the operative field with the possibility of changing the angle of the endoscope. This reduces the damage to the normal anatomical structure. Although long-term follow-up results are needed to evaluate fusion rate and complication, this appears to be a safe and feasible alternative to conventional ACDF for CSM. In this article, we have described the surgical technique, summarized the endoscopic process to discuss its operative strategies, and reviewed the radiographic records, pre- and postoperatively.Material and Methods: This retrospective review study included 36 cases aged 37 to 65 years, with CSM at one segment. All of them underwent full E-ACDF from January 2018 to April 2021. All patients were followed up for 12 months after the procedure by outpatient interviews. The clinical outcomes were evaluated based on the Visual Analog Scale (VAS) of the arm, and Japanese Orthopedic Association (JOA) score with clinical data at preoperative, 3, and 12 months after the operation. Hirabayashi method was used to assess the neurological recovery after 12 months of operation. Radiological outcomes were evaluated using plain radiography and magnetic resonance imaging, computed tomography scan to evaluate disc height, cervical lordosis (Cobb's angle), and solid fusion.Results: The mean operation time was 150 min (range 120–170 min) and the average length of hospital stay was 2 ± 3 days. There was one case of immediate postoperative anterior neck hematoma, which required open revision surgery. There was no case of infection or damage to the anterior visceral organ. The mean VAS scores for arm pain and mean JOA scores after endoscopic ACDF were significantly improved compared with before the operation during the follow-up period. The recovery rate, which was evaluated by the Hirabayashi method, looked good enough to indicate well recovered postoperatively. The disc height changed from 5.2 mm preoperatively to 6.2 mm after immediate postoperative and 5.9 mm after 6 months (P < 0.01). Cervical lordosis as Cobb's angle between C2 and C7 was significantly improved compared to the preoperative one during the follow-up periods also. The bone fusion rate was 100% at 6 months after the operation, and there was no segmental instability.Conclusions: The present study demonstrates that E-ACDF is a minimally invasive and effective surgical option for the surgical management of CSM. Based on the present study, E-ACDF may potentially enable the avoidance of various shortcomings related to surgical approaches. Through a sort of preliminary investigation, the authors confirmed the feasibility of E-ACDF and presented comparable outcome results, which might dispel the safety concern because of only one complication of wound hematoma. Better-designed randomized controlled studies with larger sample sizes in longer-term follow-ups are strongly warranted.

Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population.

This was a large database study. The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion). CSM is a major contributor to disability and reduced quality of life worldwide. Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used. Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086). The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.

Clinical and Radiological Evaluation of Cervical Spondylotic Myelopathy Operated With Posterior Decompression and Lateral Mass Fixation- a Retrospective Review with Minimum Two Years Follow-Up

Objective: There is controversy in surgical management of cervical spondylotic myelopathy (CSM); a few group encourage only laminectomy or laminoplasty while the others emphasize on lateral mass fixation along with laminectomy. Cervical lordosis is an important factor for maintaining posture neck and preventing postoperative axial neck pain. Literature has reported that cervical lordosis less than -20 degrees is often responsible for neck pain. The purpose of this study was to evaluate clinical outcome and radiological parameters after posterior cervical laminectomy and fixation in CSM. Material and Methods: This retrospective study included 37 patients operated with posterior cervical decompression and lateral mass screw fixation with minimum two-year follow-up. All patients were operated for CSM. All were operated by a single surgeon and followed up at six weeks, twelve weeks, six months, one year and yearly afterwards. Clinical outcome and radiological parameters were analyzed for clinical improvement [European Myelopathy Score (EMS)] and cervical lordotic angle. Results: Average age 68±8.3 years. The cervical lordotic angle of -23.02±4.19 degrees was maintained in patients operated with lateral mass screw fixations along with laminectomy at final follow-up. The EMS and VAS score showed significant improvement postoperatively from 15.7 to 13.6 (p&lt;0.05) and 8.1 to 1.5 (p&lt;0.05), respectively. Three patients had postoperative C5 palsy that recovered completely within three months. Two patients expired within a few months after surgery due to acute myocardial infarction and respiratory arrest, respectively. There were three patients who had postoperative C5 palsy, which recovered completely within three months postoperatively. There was no permanent postoperative neurological deficit noticed in the series. Conclusion: Posterior cervical lateral mass screw fixation for CSM gives satisfactory clinical outcome and maintains cervical lordosis. Lateral mass fixation with

Review of laminoplasty versus laminectomy in the surgical management of cervical spondylotic myelopathy

Background: We reviewed the literature comparing the indications/efficacy of laminectomy (LA) with or without fusion versus laminoplasty (LP) in the treatment of cervical spondylotic myelopathy (CSM).Methods: We identified 14 studies in PubMed/Medline to include in our analysis. Outcomes were assessed utilizing the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS), Neck Disability Index, and Nurick scale. Variables studied included ossification of the posterior longitudinal ligament (OPLL), cervical range of motion (ROM), the C2-C7 sagittal Cobb angle, the Ishihara index, and the Hirabayashi scale. Patients with cervical trauma/fracture, infection, or tumor were excluded from the study.Results: In these 14 studies, there were no significant differences between LA and LP groups in terms of preoperative versus postoperative: JOA scores (e.g., including the improvement rate), VAS scores, and ROM. However, the LA patients demonstrated greater postoperative cervical lordosis versus those in the LP group.Conclusion: At present, there are no guidelines for choosing LA versus LP for treating CSM. Factors that should be considered when choosing one procedure over the other should include the patients’ preoperative clinical status, the type of CSM, the pathological extent of OPLL, and whether there is a sufficient cervical lordotic curvature.

Current Management of Cervical Spondylotic Myelopathy.

Cervical spondylotic myelopathy (CSM) develops insidiously as degenerative changes of the cervical spine impact the spinal cord. Unfortunately, CSM is a form of spinal cord injury in older patients that often experiences delayed treatment. This summary evaluates the pathophysiology, natural history, diagnosis, and current management of CSM. Frequently, patients do not appreciate or correlate their symptomatology with cervical spine disease, and those with radiographic findings may be clinically asymptomatic. Providers should remember the classic symptoms of CSM-poor hand dexterity, new unsteady gait patterns, new onset and progressive difficulty with motor skills. An magnetic resonance imaging is required in patients with suspected CSM, but computerized tomography myelography is an alternative in patients with implants as contraindications to magnetic resonance imaging. The management of those with CSM has continued to be a controversial topic. In general, patients with incidental findings of cervical cord compression that are asymptomatic can be managed conservatively. Those with daily moderate-severe disease that significantly affects activities of daily living should be treated operatively.

What Is the Superior Screw Fixation Technique for Posterior Decompression and Fusion in the Management of Cervical Spondylotic Myelopathy: Pedicle Screw or Lateral Mass Screw?

What Is the Superior Screw Fixation Technique for Posterior Decompression and Fusion in the Management of Cervical Spondylotic Myelopathy: Pedicle Screw or Lateral Mass Screw?

Magnetic resonance imaging and dynamic X-ray\u2019s correlations with dynamic electrophysiological findings in cervical spondylotic myelopathy: a retrospective cohort study

BackgroundDynamic somatosensory evoked potentials (DSSEP) can be used to disclose abnormalities of ascending sensory pathways at dynamic positions and diagnose cervical spondylotic myelopathy (CSM). However, radiographic tests including magnetic resonance imaging (MRI) and dynamic X-ray are used much more widely in the management of CSM. Our study aims to clarify the correlations between several radiographic parameters and the DSSEP results, and further determine their reliability with clinical data.MethodsWe retrospectively enrolled 38 CSM patients with surgical intervention. DSSEP tests were performed before surgery. Amplitude ratios of DSSEP N13 and N20 waves at extension and flexion were calculated and recorded as N13_E, N20_E, N13_F, N20_F, respectively. Baseline severity was evaluated with the modified Japanese Orthopedic Association (mJOA) score and the Nurick grades. Prognosis was evaluated based on the 2-year recovery rate. Sagittal diameter and transverse areas of the cord and canal were measured and the the compressive ratios at the compressed site (Compression_Ratio), central (Central_Ratio), and 1/4-lateral points (1/4-Lateral_Compression_Ratio), and spinal cord/Canal Area Ratio were calculated. The intramedullary T2 hyperintensity patterns (Ax-CCM types) were also collected from MRI axial images. Dynamic X-rays were used to test for segmental instability of the cervical spine. The correlations between radiologic findings, DSSEP data, and clinical assessments were investigated.ResultsWe found that DSSEP N13_E and N13_F correlated with the Compression_Ratio, Central_Ratio, 1/4-Lateral_Compression_Ratio (Pearson, p < 0.05) and Ax-CCM types (ANOVA, p < 0.05) in MRI axial images and cervical segmental instability in dynamic X-ray (t-test, p < 0.05). Apart from the 1/4-Lateral_Compression_Ratio, these radiographic parameters above also correlated with the baseline clinical assessments (Spearman or ANOVA or t-test, p < 0.05) and postoperative recovery rate (Pearson or ANOVA or t-test, p < 0.05).ConclusionsWe found that the preoperative Compression_Ratio, Central_Ratio and 1/4-Lateral_Compression_Ratio in MRI and cervical segmental instability in dynamic X-ray could reflect the dynamic neural dysfunction of the spinal cord. Different Ax-CCM types corresponded to different DSSEP results at extension and flexion, suggesting divergent pathophysiology. These radiographic parameters could help evaluate disease severity and predict postoperative prognosis.

Intra- and Post-Complications of Cervical Laminoplasty for the Treatment of Cervical Myelopathy: An Analysis of a Nationwide Database.

Retrospective database study. To assess the intra- and postoperative complications of cervical laminoplasty and to evaluate the effect of intraoperative neuromonitoring use on postoperative limb paralysis incidence. Cervical laminoplasty is a known procedure for the management of cervical spondylotic myelopathy (CSM). This was a retrospective study of 532 patients with CSM who underwent cervical laminoplasty between 2007 and the first quarter of 2016 using the Humana subset of the PearlDiver Database. The database was queried using the relevant International Classification of Diseases (ICD-9 and ICD-10) codes for CSM and Current Procedural Terminology (CPT) codes for cervical laminoplasty. The intra- and postoperative incidence of surgical and medical complications and reoperations was then determined and was compared with a propensity score-matched cohort of patients who had posterior laminectomy and fusion (490 patients in each group), using multivariate logistic regression analysis. Laminoplasty was associated with a lower incidence of dysphagia (odds ratio [OR] = 0.37, 95% confidence interval [CI] = 0.16-0.79; P = 0.014), 30-day readmission (OR = 0.51, 95% CI = 0.35-0.75; P < 0.001), urinary tract infection (OR = 0.58, 95% CI = 0.37-0.93; P = 0.023), and incision and drainage, exploration or evacuation (OR = 0.28, 95% CI = 0.08-0.79; P = 0.026). The use of intraoperative neuromonitoring was associated with a non-significant lower incidence of limb paralysis within 1 and 3 months postoperatively (OR = 0.52 and 0.51, 95% CI = 0.23-1.19 and 0.23-1.11; P = 0.119 and 0.091, respectively). Compared with posterior laminectomy and fusion, laminoplasty had lower rates of dysphagia, urinary tract infection, and 30-day readmission. The use of intraoperative neuromonitoring was associated with a lower risk of postoperative limb paralysis, but it did not achieve statistical significance. 4.

Cervical Spondylotic Myelopathy: A Guide to Diagnosis and Management.

Cervical spondylotic myelopathy (CSM) is a neurologic condition that develops insidiously over time as degenerative changes of the spine result in compression of the cord and nearby structures. It is the most common form of spinal cord injury in adults; yet, its diagnosis is often delayed. The purpose of this article is to review the pathophysiology, natural history, diagnosis, and management of CSM with a focus on the recommended timeline for physicians suspecting CSM to refer patients to a spine surgeon. Various processes underlie spondylotic changes of the canal and are separated into static and dynamic factors. Not all patients with evidence of cord compression will present with symptoms, and the progression of disease varies by patient. The hallmark symptoms of CSM include decreased hand dexterity and gait instability as well as sensory and motor dysfunction. magnetic resonance imaging is the imaging modality of choice in patients with suspected CSM, but computed tomography myelography may be used in patients with contraindications. Patients with mild CSM may be treated surgically or nonoperatively, whereas those with moderate-severe disease are treated operatively. Due to the long-term disability that may result from a delay in diagnosis and management, prompt referral to a spine surgeon is recommended for any patient suspected of having CSM. This review provides information and guidelines for practitioners to develop an actionable awareness of CSM.

Prognostic Factors of Anterior Surgical Approach in Management of Cervical Spondylotic Myelopathy

Background: Spondylotic cervical myelopathy is defined as spinal cord dysfunction secondary to extrinsic compression of the spinal cord and/or its vascular supply so it is the commonest cause of cord dysfunction in patients over 55 years. Main Surgery target is to prevent the progression of symptoms also to improve existing symptoms.Aim of the work: To determine prognostic factors of patients with spondylotic cervical myelopathy that surgically managed through anterior approach in relation to outcome clinically and radiologically.Patients and methods: From July 2015 till December 2018, forty patients with cervical myelopathy were operated by anterior surgical approach (anterior cervical discectomy with fusion and/or corpectomy with fusion. Only patients with confirmed spondylotic myelopathy were included; we exclude those with an infectious, inflammatory or neoplastic etiology.Results: Patients ages were ranged from (40-67) years, with a mean age 53.2 years. Duration of myelopathy ranged from 2-18 months with a mean duration of 8.55 months. 72.5% patients were treated by discectomy with fusion and 27.5%cases were treated by combined discectomy and corpectomy with fusion. Excellent outcome was reported in 22.5%, while 62.5% cases had good outcome,15% patients had fair outcome. Patient age, disease severity, duration, bowel & bladder manifestations and affection of dorsa column were the prognostic factors in studied patients. Conclusion: Our study reveals that the significant prognostic factors are: age of patient, severity of myelopathy, duration of myelopathy, presence of bowel or bladder symptoms, dorsal column affection and high signal intensity of T2 weighted MRI.

Prognostic Factors in the Surgical Management of Cervical Spondylotic Myelopathy: Our Experience

Prognostic Factors in the Surgical Management of Cervical Spondylotic Myelopathy: Our Experience

Evaluation of Results of Anterior Cervical Discectomy Fusion (ACDF) by Cervical Cage with Bone Graft for the Treatment of Single Level Cervical Spondylotic Myelopathy

Background: Cervical spondylotic myelopathy (CSM) is a common spinal cord disorder that develops in elderly people. Anterior cervical decompression and fusion (ACDF) is an effective and reliable procedure for the treatment of CSM.&#x0D; Objective: To find out the results of ACDF by cervical cage with bone graft for the treatment of single level cervical spondylotic myelopathy.&#x0D; Methods: This prospective observational study was conducted in the Department of Orthopedics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, over a period of two years from March 2015 to August 2017. Forty patients with cervical spondylotic myelopathy were diagnosed on the basis of presenting complains, clinical examination and investigations and were enrolled in this study. The history of the patients was collected, clinical examination was done and relevant investigations were done for each patient. In this study, Nurick grading and VAS scale were used for evaluation of the result.&#x0D; Result: Male gender was predominant in this study; male-female ratio was 2.63:1. Mean age of the patients was 45.9 ± 9.1 years within the range of 30-65 years. Both sides were affected in 14 (35.0%) cases, only right side was affected in 15 (37.5%) cases and only left side was affected in 11 (27.5%) cases. Involved disc spaces were C3/4 (10.0%), C4/5 (22.5%), C5/6 (42.5%) and C6/7 (25.0%). Transientdysphagia was observed in 2 (5.0%), transient para paresis in 1 (2.5.0%), wound infection in 1(2.5.0%) case and damage to the dura was observed in 1 (2.5.0%) case. Signs of fusion were observed in 10 (25.0%) cases after 3 months, 30 (75.0%) cases after 6 months and in all patients after 12months. The result was found to be excellent in 35 (87.5%) and good in 5 (12.5%) cases.&#x0D; Conclusion: Anterior cervical discectomy and fusion by cervical cage with bone graft is an effective procedure for management of CSM.