Myelopathy Research Articles

The Association of Race, Rurality, and Neighborhood Disadvantage with Disease Severity at Initial Presentation in Cervical Spondylotic Myelopathy: A Cohort Study.

Retrospective Cohort Study. To examine the impact of neighborhood-level socioeconomic factors on the delay of care and severity of disease among DCM patients at initial presentation. Degenerative Cervical Myelopathy (DCM) is the most common etiology for spinal cord dysfunction among adults worldwide. Previous literature has suggested that social determinants of health including neighborhood-level socioeconomic status such as Area of Deprivation Index (ADI) may impact spine surgery outcomes in DCM. We performed a single-institution retrospective analysis of all patients undergoing spine surgery for the treatment of DCM from 2010 to 2022. Patients were identified using CPT and ICD9/10 codes. Data was collected via review of the electronic medical record. ADI was extracted from patients addresses. Multivariate and univariate analysis was used to assess the relationship between socioeconomic variables and myelopathy characteristics. A total of 490 patients (Mean age: 60.3±11.3y) were identified. Residence in rural areas was associated with higher Nurick score (OR 2.48,P=0.011), and lower mJOA score (OR 2.51, P=0.014) at presentation, and longer times to presentation (HR 0.48, P=0.003). Having high ADI was independently associated with shorter times to presentation (HR 1.46,P<0.001), but predicted higher Nurick score (OR 1.6, P=0.021) and lower mJOA score (OR 1.86,P=0.002). Unemployment was associated with longer times to presentation (HR 0.66,P<0.001), higher Nurick score (OR 4.5,P<0.001), and lower mJOA score (OR 4.51, P<0.001), while race was not. This is the first single institution study investigating the influence of neighborhood-level measures such as ADI on presentation status and disease burden in patients with DCM. High ADI predicts shorter disease duration but more severe DCM symptoms. Rural residence, unemployment, and non-private insurance were independently associated with prolonged and more severe DCM symptoms while race was not. 3.

Mid- to long-term clinical outcomes of modified technique skip-level titanium plate fixation in cervical laminoplasty compared to continuous fixation

PurposeTo compare the efficacy and safety of skip titanium plates combined with adjacent spinous process suture suspension versus continuous titanium plate fixation in cervical laminoplasty.MethodsA retrospective analysis of 125 patients (62 men, 63 women, average age 60.9 ± 10.4 years) with multilevel cervical spondylotic myelopathy who had cervical laminoplasty with Arch titanium plate fixation from January 2012 to March 2024 in our hospital was done. Patients were stratified into two cohorts based on the fixation technique: Group A (n = 64): Modified technique of skip-level titanium plate fixation (Arch titanium plates at C4 and C6 levels combined with adjacent spinous process suture suspension)Group B (n = 61): Continuous plating (Arch titanium plates applied sequentially from C3 to C7).The comparative analysis focused on perioperative parameters (operative duration, intraoperative blood loss, length of hospital stay), economic factors (hospital costs), and various clinical indicators.ResultsThe average follow up period was (73.0 ± 38.4) months. Both groups showed no significant differences in gender, age, and disease duration (P > 0.05). Group A had lower hospitalization costs, intraoperative blood loss, operation time, and postoperative hospital stay compared to Group B (P < 0.05). Postoperatively, both groups had significant improvements in JOA scores and NDI (P < 0.005), but there were no significant differences in postoperative scores and improvement rates between the two groups (P > 0.05). At 3 months postoperatively and at the last follow-up, the C2-7 Cobb angle and cervical curvature index decreased compared to preoperative values (P < 0.05), with a significant difference in the C2-7 Cobb angle at the last follow-up (P < 0.05). The sagittal diameter of the spinal canal from C3 to C7 significantly increased (P < 0.05), but there were no significant differences in the improvement of C3, C5, and C7 between the two groups (P > 0.05). At 3 months postoperatively, the opening angles of the C4 and C6 laminae in Group A were smaller than those in Group B (P < 0.05), but there were no significant differences at the last follow-up (P > 0.05). The healing of the C4 and C6 laminae in Group B was superior to that in Group A (P < 0.05), but there were no differences in healing at the last follow-up (P > 0.05). The incidence of axial symptoms was similar (10.9% in Group A and 14.8% in Group B, P = 0.523).ConclusionsDuring C3-7 laminoplasty, the clinical efficacy of the method combining mini titanium plate fixation (at C4 and C6) with suture fixation is comparable to that of continuous fixation. Moreover, it has an advantage in cost control.

Possible involvement of vitamin K insufficiency in the progression of cervical ossification of the posterior longitudinal ligament

Ossification of the posterior longitudinal ligament of the vertebral column (OPLL) is a disease characterised by ectopic bone formation in the spinal ligament that causes progressive neurological impairment. However, there are no suitable treatments for OPLL. Here, we compared the general characteristics and haemostasis of patients with OPLL and those with cervical spondylotic myelopathy. Those with OPLL had significantly longer prothrombin times and lower plasma protein C concentrations, consistent with vitamin K deficiency. Therefore, we next characterised the effects of vitamin K supplementation on spinal hyperostosis in ttw mice, a model of cervical OPLL, by feeding them standard chow, vitamin K-deficient chow, or standard chow accompanied by biweekly vitamin K2 injections for 6 weeks. We found that vitamin K supplementation resulted in longer stride lengths and superior inter-limb coordination using footprint analysis. Furthermore, supplementation caused a significant reduction in ectopic calcification of the cervical ligaments of the mice, according to microcomputed tomography analysis. Finally, supplementation caused an increase in the number of osteochondrogenic cells expressing Gla-rich protein, an inhibitor of ectopic calcification, and increased the circulating concentration. Thus, vitamin K insufficiency may be involved in the pathogenesis of OPLL and supplementation may represent a novel treatment for this condition.

THE ROLE OF DYNAMIC CERVICAL MRI IN DETERMINING THE LEVEL OF POSTERIOR DECOMPRESSION IN CERVICAL SPONDYLOTIC MYELOPATHY.

Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static MRI is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess. Eighty-two CSM patients undergoing posterior decompression surgery were divided into two groups: static MRI-based planning (n=43) and combined static and dynamic MRI-based planning (n=39). Neurological outcomes were evaluated using modified Japanese Orthopaedic Association (mJOA) and Visual Analog Scale (VAS) scores pre- and postoperatively. Compression levels identified on static and dynamic MRI were compared. Demographic characteristics were similar between groups. Dynamic MRI identified additional compression levels, mainly at C5-C6 and C6-C7, in 18 patients. Patients in the dynamic MRI group showed significantly greater improvements in mJOA scores (mean: 15.8 ± 1.6 vs. 14.5 ± 1.8, p=0.01) and VAS scores (mean: 3.2 ± 1.4 vs. 4.5 ± 1.8, p=0.01) compared to the static MRI group. Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases.

Sexual Dysfunction in Cervical Spondylomyelopathy and Its Prognosis Following Surgical Decompression: A Systematic Review.

Systematic review. While the occurrence of sexual dysfunction in patients sustaining traumatic cervical or thoracic injuries is well acknowledged, the evidence regarding its prevalence and outcome in individuals with degenerative cervical myelopathy (DCM) is still limited. The current systematic review was planned to comprehensively evaluate the existing literature regarding the prevalence, patterns, presentation, and outcome of sexual dysfunction in patients presenting with DCM. A thorough search of the literature was performed on October 15, 2024, using 5 different databases (Google Scholar, Embase, PubMed, Web of Science and Cochrane Library). Studies on sexual dysfunction in DCM published until 2024 were scrutinized. Narrative or systematic reviews, opinions, letters to the editor, and manuscripts published in non-English languages were excluded. Overall, the literature search yielded a total of 384 articles of which 7 articles with 910 patients were included in the analysis. The overall prevalence of erectile dysfunction (ED) in CSM ranges between 3 and 6%. 82% of patients with preoperative ED had an abnormal psychogenic erection while the remaining had an abnormal reflexogenic erectile function. The erectile function was reported to improve substantially following decompressive surgery (68% recovery rate; P = 0.05). The presence of preoperative sexual dysfunction has been associated with poorer neurological outcomes (50% recovery rate; including poorer gait recovery). The data regarding ejaculatory disturbances and female sexual dysfunction in DCM patients are still limited. ED occurs in 3 to 6% of patients with DCM, with a majority of patients suffering from ED from psychogenic origin. Surgical decompression can significantly improve the sexual recovery in these patients. Patients with ED have overall poorer neurological recovery.

Cervical spondylotic myelopathy and radiculopathy: a stepwise approach and comparative analysis of surgical outcomes: a narrative review of recent literature.

Selecting the optimal surgical treatment for multilevel cervical spondylotic myelopathy and radiculopathy significantly affects symptom improvement, postoperative prognosis, and quality of life. Proper patient selection and precise surgical execution are crucial for achieving successful outcomes, considering the favorable natural course of cervical radiculopathy. Several factors must be considered, including the number of affected segments, spinal alignment, kyphosis degree, stiffness, and surgeon expertise, when determining the surgical approach for cervical spondylotic myelopathy. An anterior approach is commonly used in cases that involve fewer than three segments with mild kyphosis, whereas posterior laminoplasty or anterior cervical discectomy and fusion (ACDF) are effective for cases with more than three segments with maintained lordosis. Both the degree of stiffness and spinal cord compression need to be considered for cases with kyphotic deformity. ACDF may be suitable when anterior structures are the primary source of compression and mild kyphosis is present. The decision between laminoplasty or laminectomy and fusion depends on the kyphosis degree for multilevel compression with kyphosis. An evaluation of cervical rigidity is required for severe kyphosis, and posterior laminectomy and fusion may be effective for flexible kyphosis, whereas a staged posterior-anterior-posterior approach may be required for rigid kyphosis to address both deformity and neural compression. This review summarizes recent research and presents illustrative cases of optimal surgical decision-making for various cervical spondylotic radiculopathy and myelopathy presentations.

Magnetic resonance imaging evaluation of cervical paraspinal muscles in dropped head syndrome.

The pathomechanism of dropped head syndrome (DHS) is unclear. In this study, we aimed to examine the features of the paraspinal cervical muscles in patients with DHS by analyzing the volume of these muscles using magnetic resonance imaging (MRI). Thirty-six patients with DHS and 25 patients with cervical spondylotic myelopathy (controls) were enrolled. The volume analyzer measured the cross-sectional area (CSA) of the paraspinal muscles on the axial image of a T2-weighted MRI at each level, from C2/3 to C6/7. The histogram used pixel intensities to measure the fat infiltration in the extensor muscles. The data were compared between the groups. The CSA of the semispinalis capitis and the splenius capitis and cervicis from the extensor muscles in DHS was larger than that of the control group at almost all levels. The CSAs of other extensor muscles were equivalent to those of the controls. The CSA of the sternocleidomastoideus in DHS was smaller than in the control group at C4/5/6/7. The CSA of any extensor muscle in the chronic group of the DHS was smaller than that of the acute group at the lower levels. The percentage of fat infiltration was not significantly different between the groups. MRI analyses of the present study revealed that neither the extensor muscles in DHS were atrophic nor the flexor muscles were hypertrophic. Further, fatty infiltration of the extensor muscles may not induce muscle weakness of the extensors in patients with DHS.

Intramedullary Stress and Strain Correlate with Neurological Dysfunction in Degenerative Cervical Myelopathy

Intramedullary Stress and Strain Correlate with Neurological Dysfunction in Degenerative Cervical Myelopathy

Characterizing brain network alterations in cervical spondylotic myelopathy using static and dynamic functional network connectivity and machine learning.

Cervical spondylotic myelopathy (CSM) is a debilitating condition that affects the cervical spine, leading to neurological impairments. While the neural mechanisms underlying CSM remain poorly understood, changes in brain network connectivity, particularly within the context of static and dynamic functional network connectivity (sFNC and dFNC), may provide valuable insights into disease pathophysiology. This study investigates brain-wide connectivity alterations in CSM patients using both sFNC and dFNC, combined with machine learning approaches, to explore their potential as biomarkers for disease classification and progression. A total of 191 participants were included in this study, comprising 108 CSM patients and 83 healthy controls (HCs). Resting-state fMRI data were used to derive functional connectivity networks (FCNs), which were further analyzed to obtain sFNC and dFNC features. K-means clustering was applied to identify distinct dFNC states, and machine learning models, including support vector machine (SVM), decision tree (DT), linear discriminant analysis (LDA), logistic regression (LR), and random forests (RF), were constructed to classify CSM patients and HCs based on FNC features. The sFNC analysis revealed significant alterations in brain network connectivity in CSM patients, including enhanced connectivity between the posterior default mode network (pDMN) and ventral attention network (vAN), and between the right and left frontoparietal networks (rFPN and lFPN), alongside weakened connectivity in multiple other network pairs. K-means clustering of dFNC identified four distinct functional states, with CSM patients exhibiting altered connectivity in State 1 and State 3. Machine learning models based on sFNC demonstrated excellent classification performance, with the SVM model achieving an AUC of 0.92, accuracy of 85.86%, and sensitivity and specificity both exceeding 0.80. Models based on dFNC also performed well, with the State 3-based model yielding an AUC of 0.91 and accuracy of 84.97%. Our findings highlight significant alterations in both sFNC and dFNC in CSM patients, suggesting that these connectivity changes may reflect underlying neural mechanisms of the disease. Machine learning models based on FNC features, particularly SVM, exhibit strong potential for classifying CSM patients and may serve as valuable neuroimaging biomarkers for diagnosis and monitoring disease progression. Future research should explore longitudinal studies and multimodal neuroimaging approaches to further validate these findings.

Augmenting Large Language Models With Automated, Bibliometrics-Powered Literature Search for Knowledge Distillation: A Pilot Study for Common Spinal Pathologies

BACKGROUND AND OBJECTIVES: Scholarly output is accelerating in medical domains, making it challenging to keep up with the latest neurosurgical literature. The emergence of large language models (LLMs) has facilitated rapid, high-quality text summarization. However, LLMs cannot autonomously conduct literature reviews and are prone to hallucinating source material. We devised a novel strategy that combines Reference Publication Year Spectroscopy—a bibliometric technique for identifying foundational articles within a corpus—with LLMs to automatically summarize and cite salient details from articles. We demonstrate our approach for four common spinal conditions in a proof of concept. METHODS: Reference Publication Year Spectroscopy identified seminal articles from the corpora of literature for cervical myelopathy, lumbar radiculopathy, lumbar stenosis, and adjacent segment disease. The article text was split into 1024-token chunks. Queries from three knowledge domains (surgical management, pathophysiology, and natural history) were constructed. The most relevant article chunks for each query were retrieved from a vector database using chain-of-thought prompting. LLMs automatically summarized the literature into a comprehensive narrative with fully referenced facts and statistics. Information was verified through manual review, and spine surgery faculty were surveyed for qualitative feedback. RESULTS: Our tandem approach cost less than $1 for each condition and ran within 5 minutes. Generative Pre-trained Transformer–4 was the best-performing model, with a near-perfect 97.5% citation accuracy. Surveys of spine faculty helped refine the prompting scheme to improve the cohesion and accessibility summaries. The final artificial intelligence–generated text provided high-fidelity summaries of each pathology's most clinically relevant information. CONCLUSION: We demonstrate the rapid, automated summarization of seminal articles for four common spinal pathologies, with a generalizable workflow implemented using consumer-grade hardware. Our tandem strategy fuses bibliometrics and artificial intelligence to bridge the gap toward fully automated knowledge distillation, obviating the need for manual literature review and article selection.

Pre- and Intraoperative Factors Associated With Improvement of Neck Pain After Laminoplasty for the Treatment of Cervical Myelopathy.

Retrospective cohort study. To (1) determine whether preoperative neck pain improves after laminoplasty for cervical myelopathy and identify factors that could predict improvements in neck pain. A total of 88 patients with preoperative neck pain visual analogue scale (VAS) of ≥4, who underwent laminoplasty for cervical myelopathy, and were followed-up for >2years were retrospectively reviewed. Patients demonstrating ≥50% improvement in VAS scores for neck pain 2years postoperatively compared toㅇ preoperative assessment were included in neck pain improved (NP-improved) group. The remaining patients were assigned to neck pain unimproved (NP-unimproved) group. Overall, 54 patients (61.4%) were included in NP-improved group and 34 patients (38.6%) were included in NP-unimproved group. NP-unimproved group more frequently underwent C3 laminectomy (P = 0.026) and had lesser degree of preoperative C2-C7 lordosis (P = 0.006) in the extension position compared to that in the NP-improved group. Furthermore, undergoing C3 laminectomy was associated with lower probability of achieving a ≥50% improvement in neck pain VAS scores (P = 0.018), while greater preoperative C2-C7 lordosis in the extension position was associated with a higher possibility of neck pain improvement (P = 0.048). A cut-off value of 20.5° for C2-C7 lordosis in the extension position predicted a ≥50% improvement in neck pain. Preoperative neck pain should not be considered contraindication for laminoplasty as 61.4% of patients experienced ≥50% improvement in neck pain post-operatively. C3 laminectomy decreases the probability of neck pain improvement after laminoplasty, while greater C2-C7 lordosis in the extension position is associated with neck pain improvement.

The role of paraspinal muscle degeneration in cervical spondylosis.

To explore the relationship between paraspinal muscle degeneration and cervical spondylosis through cervical spine MRI and lateral X-ray. A retrospective study included 83 cervical spondylosis patients as the experimental group, consisting of 28 axial joint pain (Group A), 29 cervical radiculopathy (Group B), and 26 myelopathy (Group C), as well as 29 healthy individuals as the control group (Group D). The cross-sectional area (CSA) of paraspinal muscles at the C3-4, C4-5, and C5-6 segments was measured, including the deep extensor area (DEA), deep flexor area (DFA), and superficial extensor area (SEA). Additionally, fatty infiltration (FI) ratio was calculated, namely the deep extensor fatty infiltration ratio (DEFIR), deep flexor fatty infiltration ratio (DFFIR), and superficial extensor fatty infiltration ratio (SEFIR). Correlations of CSA and FI ratio with age, body mass index, Pfirrmann grading, and Cobb angle were analyzed. (1) Pfirrmann grading in groups A, B, and C was significantly higher than that in group D (P < 0.001), with group C higher than groups A and B (P < 0.05), but the difference between groups A and B was not statistically significant (P > 0.05). (2) There was no significant difference in the CSA among groups (P > 0.05). For DEFIR and DFFIR, group C > group B > group A > group D, with significant differences (P < 0.05). For SEFIR, groups A, B, and C were significantly higher than group D (P < 0.001), with no significant differences between the other pairs (P > 0.05). (3) The CSA of males was significantly greater than females (P < 0.001), while the difference in FI ratio was not significant (P > 0.05). (4) In the control group, DEFIR and DFFIR were positively correlated with age (r = 0.538, P = 0.003; r = 0.829, P < 0.001) and negatively correlated with Cobb angle (r=-0.523, P = 0.004; r=-0.535, P = 0.003). In the experimental group, DEFIR and DFFIR were positively correlated with age (r = 0.731, P < 0.001; r = 0.741, P < 0.001) and Pfirrmann grading (r = 0.778, P < 0.001; r = 0.812, P < 0.001), and negatively correlated with Cobb angle (r=-0.507, P < 0.001; r=-0.539, P < 0.001). There were no correlations between the other parameters. In cervical spondylosis patients, the FI ratio of the deep cervical muscle is linked to both worsening disc degeneration and changes in cervical spine alignment. Among the different subtypes, cervical myelopathy shows the highest FI ratio of the deep cervical muscle and disc degeneration, indicating its significant impact on spinal structure and muscular integrity.

Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion

ObjectiveThis study presents a novel odontoid parameter, the odontoid incidence (OI), to examine the correlation between OI on preoperative cervical sagittal radiographs and 2-year clinical outcomes following short-segment anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).MethodsA retrospective analysis of the clinical data of 87 patients with CSM who underwent ACDF surgery from January 2018 to December 2023 was conducted. The patients were categorized into a larger OI group (44 patients, OI > 12.62°) and a smaller OI group (43 patients, OI ≤ 12.62°) on the basis of the median cervical sagittal OI prior to surgery. The postoperative follow-up duration was 2 years. Cervical sagittal parameters were assessed on lateral cervical spine radiographs both preoperatively and postoperatively. Additionally, the Japanese Orthopedic Association (JOA), neck disability index (NDI), and visual analog scale (VAS) scores were documented for each patient before surgery and at the final 2-year postoperative follow-up.ResultsCompared with those in the preoperative period, the T1 slope, C2‒C7 Cobb angle, sagittal segmental angle (SSA), and C0‒C2 Cobb angle significantly improved in 87 patients with cervical spondylosis (P < 0.05). At the 2-year postoperative follow-up, all patients exhibited significant improvements in JOA, NDI, and VAS scores compared with the preoperative values (P < 0.05). No statistically significant difference was observed in the preoperative or baseline data between the larger OI group and the smaller OI group (P > 0.05); however, a statistically significant difference was noted in the postoperative SSA between the two groups (P < 0.05). A statistically significant difference was observed in the VAS score and NDI score at the final follow-up between the two groups (P < 0.05), as well as in the improvement in the JOA score and VAS score (preoperative score minus the final follow-up score), between the two groups (P < 0.05). The results of the Pearson correlation analysis indicated a negative correlation between the preoperative OI score and the VAS and NDI scores at the final postoperative follow-up (P = 0.012, r = − 0.268) (P = 0.028, r = − 0.236).ConclusionIn ACDF, the preoperative OI of patients with CSM was negatively correlated with the VAS and NDI scores at the final postoperative follow-up; Larger preoperative OI corresponded to lower VAS and NDI scores at the final follow-up, leading to comparatively improved 2-year clinical outcomes.

Patient-reported outcome trajectories the first 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Cervical spondylotic myelopathy (CSM) shows varying levels of improvement after surgical treatment. While some patients improve soon after surgery, others may take months to years to show any signs of improvement. The goal of this study was to evaluate postoperative improvement, patient-reported outcomes, and patient satisfaction up to 2 years after surgical treatment for CSM, which will help optimize the current treatment strategies and effectively manage patient expectations. This was a retrospective study of prospectively collected data using the Quality Outcomes Database. The primary outcomes of interest were achievement of the minimal clinically important difference (MCID) for the numeric rating scale for neck and arm pain, modified Japanese Orthopaedic Association, Neck Disability Index, and EQ-5D scores and postoperative satisfaction (North American Spine Society scale). Early and sustained improvement was defined as MCID achievement in at least one patient-reported outcome measure (PROM) at the 3-, 12-, and 24-month follow-ups. Transient improvement was defined as MCID achievement only at the 3-month and/or 12-month follow-up but not at the 24-month follow-up. Late improvement was defined as MCID achievement in at least one PROM only at the 24-month follow-up. There were 630 patients included in the comparative analysis. A total of 463 (73.5%) patients achieved early and sustained improvement, 105 (16.7%) patients experienced transient improvement with subsequent decline, 25 (4.0%) patients reported late improvement, and 37 (5.9%) patients did not report any clinically meaningful improvement after surgery. Patients with an anterior approach were more likely to be in the early and sustained improvement group. African American patients (OR 2.98, 95% CI 1.14-7.76; p = 0.03) were more likely to report late improvement when compared with White patients. The overall satisfaction rate at the 24-month follow-up was 87.8%. These findings indicate that 73.5% of patients achieve early and sustained improvement, and 87.8% of patients are satisfied with surgery 24 months postoperatively.

Differences in Transdiaphragmatic Pressure of Dogs Suffering from Cervical or Thoracolumbar Myelopathy Anaesthetised with Isoflurane.

The purpose of this study is to evaluate differences in transdiaphragmatic pressure (Pdi) in dogs suffering from cervical myelopathy (CM) and thoracolumbar myelopathy (TLM) anaesthetised with isoflurane (ISO). This prospective cohort study included ASA II-status dogs diagnosed with either CM or TLM, anaesthetised for diagnostic or surgical purposes between September 2021 and July 2023. Patients followed the same anaesthetic protocol, and maximum Pdi was recorded at 10 (Pdimax10), 20 (Pdimax20), and 30 (Pdimax30) minutes using balloon catheters placed in the stomach (Pgast) and in the mid-third of the oesophagus (Poes). A total of 50 dogs were included: 25 in the CM group and 25 in the TLM group. In the TLM group, Pdimax10 was 9.4 mmHg ± 6.1, and in the CM group, it was 7.2 mmHg ± 4.6 (p = 0.167). Pdimax20 was 10.2 mmHg ± 5.8 in the TLM group and 8 mmHg ± 5.1 in the CM group (p = 0.155). Pdimax30 was 9.2 mmHg ± 5.5 in the TLM group and 8.1 mmHg ± 5.5 in the CM group (p = 0.479). The findings suggest that diaphragmatic contractility is similar in dogs with CM and TLM under ISO anaesthesia.

T1 mapping using MP2RAGE in degenerative cervical myelopathy: a longitudinal study.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord (SC) dysfunction. In routine clinical practice, SC changes are well depicted using conventional MRI, especially T2-weighted imaging. However, this modality usually fails to provide satisfactory clinico-radiological correlations. In this context we assessed the potential value of quantitative changes measured with a T1 MP2RAGE sequence. 18 patients diagnosed with chronic onset of DCM and 17 healthy controls (HC) were enrolled in the study. Clinical presentation was assessed using the modified Japanese Orthopaedic Association (mJOA) scale. Sagittal cervical SC T2-w 3D SPACE imaging and T1 MP2RAGE mapping were performed at baseline and 3-months postoperatively. Data were processed using Matlab and the SC Toolbox. mJOA score increased from 13.3 ± 2.1 preoperatively to 14.4 ± 1.9 at follow-up (p = 0.027). Site of maximum compression (Cmax) was at C3-C4 cervical levels in 4 patients, C4-C5 in 8 patients, C5-C6 in 5 patients and C6-C7 in 1 patient. SC compression was multi-level in 7 patients and single-level in 11 patients. T2-w hyperintensity was present in 15 patients. Mean SC T1 values in the whole SC in the DCM group at baseline showed significant difference as compared to mean SC T1 values in HC group (962.2 ± 62 vs. 924.9 ± 34 ms, respectively (p < 0.0001)) but no differences could be observed between baseline and 3-month follow-up (962.4 ± 59 ms (p = 0.86)). Z-scores at baseline were - 0.05 ± 1 for mild, 1.2 ± 1.9 for moderate and 2.5 ± 1.2 for severe. Mean baseline and 3-month follow-up SC T1 values were weakly but significantly correlated to preoperative (R2 = 0.33 (p = 0.013) and postoperative mJOA (R2 = 0.29 (p = 0.024). Baseline T1 value at C2 level was significantly correlated with mJOA at 3-month follow-up (p = 0.048). T1-MP2RAGE mapping in patients with DCM demonstrated both focal and diffuse cervical SC alteration. It could thus be a biomarker for patients with DCM managed surgically.

1-year data on patient-reported outcome is enough after surgery for degenerative cervical myelopathy: a cohort study from the Swedish Spine register.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Repeated follow-ups after surgery are resource consuming. The aim was to examine whether patient-reported outcome measures (PROMs) change after the first year. The purpose of this study was to investigate whether it is necessary to obtain follow-up data from patients more than 1 year after surgery for DCM. We included individuals treated surgically for DCM in the Swedish Spine registry (Swespine), with available preoperative, 1-, and 2-year PROMs, primarily the European Myelopathy Scale (EMS) and secondarily the Neck Disability Index (NDI), and the European Quality of life Visual Analogue Scale (EQ-VAS). A tertiary analysis included available 5-year data. Median, interquartile range (IQR), and Bland-Altman plots were used to compare PROM data at different follow-up time points. 642 individuals had baseline, 1-, and 2-year follow-up data, of whom 347 also had 5-year data. EMS was 14 (12-16) preoperative, 15 (12-17) at the 1-year follow-up, and 15 (12-17) at the 2-year follow-up. Corresponding data for NDI was 38 (24-50), 25 (12-42), and 26 (12-42) and for EQ-VAS 50 (30-60), 60 (42-77), and 60 (40-75). Similar findings were seen in individuals who also had 5-year data. Bland-Altman plots indicated good agreement between 1- and 2-year data, and between 1- and 5-year data and were without proportional bias. In individuals treated for DCM no clinically meaningful change in PROMs occurred after the 1-year follow-up.

Metabolic changes of thalamus assessed by 1H-MRS spectroscopy in patients of cervical spondylotic myelopathy following decompression surgery

Metabolic changes of thalamus assessed by 1H-MRS spectroscopy in patients of cervical spondylotic myelopathy following decompression surgery

Concomitant multiple sclerosis and cervical myelopathy: A propensity-matched QOD analysis of patient-reported outcomes and return to work after cervical spine surgery.

The diagnosis of degenerative cervical myelopathy (CM) in multiple sclerosis (MS) patients is challenging due to overlapping symptomatology and radiological findings. Minimal literature reports patient reported outcomes measures (PROMs) for MS patients undergoing surgery for CM. Given the diagnostic difficulty, we aimed to determine if patients with MS have worse outcomes after elective cervical spine surgery. 126 patients who underwent surgery for CM were retrospectively obtained from the Quality Outcomes Database (QOD). 63 MS patients were age and gender matched to 63 without MS. Postoperative PROMs including Visual Analogue Scale for neck/arm pain (VAS), Neck Disability Index (NDI), and satisfaction were compared at 3 and 12 months. Postoperative complications and return to work were studied as secondary outcomes. The average age of both cohorts was 57.9 years, and 63.5 % were female. Baseline functional status and symptomatology were similar, although fewer MS patients could independently ambulate (p = .014). The operative time and length of stay were similar. MS patients had a greater average ASA grade (p = 0.018), however there were no significant differences in VAS, NDI, or satisfaction. MS patients had a higher 3-month readmission rate (p = .044), however returned to work at a similar rate greater than 70 %. PROMs do not significantly differ for CM patients with concomitant MS. Patients with MS had a higher 3-month complication rate, although readmissions were largely unrelated to the procedure. Thus, despite the diagnostic challenge of CM in MS patients, the surgical outcomes are comparable to those without MS.

Clinical characteristics associated with cervical hydrated nucleus pulposus extrusion in dogs.

Clinical characteristics of cervical hydrated nucleus pulposus extrusion (HNPE) in dogs compared to other causes of cervical myelopathy are not well described. To evaluate for clinical characteristics and mechanical ventilation likelihood associated with HNPE compared to other causes of cervical myelopathy. Three hundred seventy-seven client-owned dogs from 2010 to 2022. Cases included 46 HNPE, 192 IVDE (intervertebral disc extrusion), 30 FCEM (fibrocartilaginous embolic myelopathy), 66 CSM (cervical spondylomyelopathy), and 43 neoplasia. Retrospective study with record review and bivariate analyses. Dogs with signs of cervical myelopathy and an MRI diagnosis of HNPE, IVDE, FCEM, CSM, or neoplasia were included. When compared to dogs with other cervical myelopathies, dogs with HNPE were more likely to be older and of lower weight (median age 10 vs 8 years, P < .001; median weight 9.1 vs 20.2 kg, P < .001), be nonambulatory (89% vs 54%, P < .001), have signs of central cord syndrome (35% vs 16%, P = .002), and have nonlateralizing signs of myelopathy (65% vs 48%, P = .029). When compared to dogs with IVDE, dogs with HNPE were more likely to present with lower pain scores (30% vs 15% nonpainful, P = .002), and require mechanical ventilation (4/46 HNPE, 2/192 IVDE; odds ratio [OR] 9.0, 95% confidence interval [CI] 1.6-51.0). Compared to dogs with other cervical myelopathies, dogs with HNPE have differences in clinical characteristics, presentation and likelihood of requiring mechanical ventilation. These differences are important to consider for case management.