Natural History Of Cervical Spondylotic Myelopathy Research Articles

Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

Background/Aim. Treatment options for cervical spondylotic myelopathy (CSM) are the topic for discussion due to the lack of controlled randomized prospective studies. Also, the natural history of CSM is unpredictable and the efficacy of surgical decompression is still controversial. The aim of this prospective study was to describe the results of surgical treatment of patients with CSM in a single institution. Methods. Fifty-nine patients with symptomatic CSM were enrolled in this single-center prospective study. At the end of the follow-up period of 12 months, 50 patients were analyzed. All patients were operated on; surgical decompression was performed by anterior or posterior surgical approach. Outcome evaluations were obtained preoperatively and 12 months postoperatively by using the following outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick score and the Neck Disability Index (NDI). The functional recovery ratio was calculated postoperatively by using Hirabayashi?s formula. Results. According to our results, significant improvements were detected in all outcome variables (mJOA score, Nurick score and NDI). Also, a statistically significant improvement was observed in all three categories of patients according to the preoperative mJOA score (mild, moderate, severe). Twenty-three patients (46%) had a satisfactory functional recovery, while twenty-seven (54%) had an unsatisfactory functional recovery rate. Conclusion. Surgical treatment of CSM is a very effective treating method and it resulted in a significant improvement in all outcome measures for a 1-year follow-up period. New studies could be recommended to evaluate the course of the disease, define the optimal surgical strategy, and better determine surgical outcome predictors.

A Bibliometric Analysis and Visualization of Current Research Trends in the Treatment of Cervical Spondylotic Myelopathy.

Study Design:Bibliometric analysis.Objective:Cervical spondylotic myelopathy (CSM) has become the most common cause of spinal cord dysfunction. Many topics of CSM still remain controversial. This study aimed to illustrate the overall knowledge structure and development trends of CSM.Methods:Research data sets were acquired from the Web of Science database and the time span was defined as “2000 to 2019.” VOS viewer and Citespace software was used to analyze the data and generate visualization knowledge maps. Annual trends of publications, distribution, H-index status, co-authorship status, and research hotspots were analyzed.Results:A total of 2367 publications met the requirement. The largest number of articles was from the United States, followed by Japan, China, Canada, and India. The highest H-index was found for articles from the United States. The highest number of articles was published in Spine. The cooperation between the countries, institutes, and authors were relatively weak. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM may become a frontier in this research field.Conclusion:The number of publications showed an upward trend with a stable rise. Most of the publications are limited to a few countries and institutions with relatively weak interaction. The United States, Canada, Japan, China, and India have made significant contributions to the field of CSM. The United States is the country with the highest productivity, not only in quality but also in quantity. Cervical sagittal alignment, predictive factor, diffusion tensor imaging, and the natural history of CSM are the research hotspots in the recent years.

Recovery Process After Anterior Cervical Decompression in Patients With Cervical Spondylotic Myelopathy With Different Natural History.

An observational prospective cohort study. To investigate the influence of natural history on the recovery of patients with cervical spondylotic myelopathy (CSM) after anterior cervical decompression. The natural history of CSM has not been clearly elucidated, it remains unclear whether the natural history of CSM is associated with the recovery process after surgical treatment. Patients with CSM (n=117) after anterior cervical decompression were stratified variously on the basis of natural history features. Baseline and postoperative neurological functions were rated using the Japanese Orthopaedic Association (JOA) and patient-based self-evaluation (PBSE) scores. The minimum and maximum recovery times for sensory function, and motor functions of the upper and lower extremities were analyzed separately at time points 1-60 months after surgery. In all patients, the postoperative JOA and PBSE scores were significantly improved relative to baseline, in which sensory function recovered most quickly, followed by upper-extremity and lower-extremity motor functions. However, when compared with patients whose first symptom onset at the lower extremity, patients with the first onset at the upper extremity required less time to recover lower-extremity motor function, but more time to recover upper-extremity motor function. Patients with rapid progression had significantly lower preoperative and final JOA and PBSE scores compared with patients whose progression was steady or stepwise. Patients with preoperative symptoms ≥1 year had longer recovery time and poorer functional outcomes compared with those symptoms <1 year. In patients with CSM, the location of first symptom onset, progressive velocity of symptom, and duration of preoperative symptoms significantly influenced the recovery process after anterior cervical decompression. Level 2-observational prospective study.

Natural history, prevalence, and pathophysiology of cervical spondylotic myelopathy

This study is a narrative review performed to summarize the current knowledge about the epidemiology, natural history and pathogenesis of cervical spondylotic myelopathy (CSM). A comprehensive search was undertaken to look at all available articles between January 1, 1956 to May 1, 2018, on PubMed and the Cochrane Collaboration Library. The natural history of CSM is variable. The main determinants of the clinical course of CSM are the extent of neurological impairment, age, cervical instability, abnormalities of cord conduction, canal diameter, congenitally stenotic spinal canal and the extent of involvement and tract disruption on diffusion tensor imaging (DTI) imaging. There is little data on the true incidence and prevalence of CSM across the globe and none from India. The pathoanatomic basis of CSM is cord compression, either dynamic or static. The biological events that are thought to play a significant role in the development of CSM are ischemia, derangement of the blood-spinal cord barrier, chronic neuronal inflammation, and apoptosis. Emerging knowledge about the molecular biology holds promise for potential intervention, both for prevention and for cure, of this common and debilitating condition.

Current Diagnosis and Management of Cervical Spondylotic Myelopathy.

Study Design:Review.Objectives:Cervical spondylotic myelopathy (CSM) is a major cause of disability, particular in elderly patients. Awareness and understanding of CSM is imperative to facilitate early diagnosis and management. This review article addresses CSM with regard to its epidemiology, anatomical considerations, pathophysiology, clinical manifestations, imaging characteristics, treatment approaches and outcomes, and the cost-effectiveness of surgical options.Methods:The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives.Results:The clinical presentation and natural history of CSM is variable, alternating between quiescent and insidious to stepwise decline or rapid neurological deterioration. For mild CSM, conservative options could be employed with careful observation. However, surgical intervention has shown to be superior for moderate to severe CSM. The success of operative or conservative management of CSM is multifactorial and high-quality studies are lacking. The optimal surgical approach is still under debate, and can vary depending on the number of levels involved, location of the pathology and baseline cervical sagittal alignment.Conclusions:Early recognition and treatment of CSM, before the onset of spinal cord damage, is essential for optimal outcomes. The goal of surgery is to decompress the cord with expansion of the spinal canal, while restoring cervical lordosis, and stabilizing when the risk of cervical kyphosis is high. Further high-quality randomized clinical studies with long-term follow up are still needed to further define the natural history and help predict the ideal surgical strategy.

Surgery vs Conservative Care for Cervical Spondylotic Myelopathy: Surgery Is Appropriate for Progressive Myelopathy.

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction.1 The condition presents insidiously and is defined in terms of its clinical symptoms (gait instability, bladder dysfunction, fine finger motor difficulties) and signs (hyperreflexia, weakness, alteration of joint position sense). CSM is caused by dynamic repeated compression of the spinal cord from degenerative arthritis of the cervical spine.2 Proposed mechanisms include axonal stretch-associated injury2 and spinal cord ischemia from compression of larger vessels and impaired microcirculation.3,4 Surgery to decompress and stabilize the spine is often advocated for severe or progressive symptoms, with mixed results. About two-thirds of patients improve with surgery, while surgery does not result in improvement in 15%-30%.5 Over 112,400 cervical spine operations for degenerative spondylosis are performed annually in the US (100% increase over the past decade),6 with CSM accounting for nearly 20% of cervical spine operations in the US.7 Annual hospital charges for CSM surgery exceeds 2 billion dollars per year.6 In addition, CSM is associated with substantial postoperative outpatient expenses (e.g., physician visits, imaging, physical therapy, medications). Recently, the Institute of Medicine designated CSM as one of the top 100 national health research priorities for comparative effectiveness research.8 There is a great need for modern prospective studies with validated outcomes tools to assess the effectiveness of surgical treatments for CSM. Most American cervical spine experts (both orthopaedic and neurological surgeons) believe that there is sufficient clinical equipoise to support a comparative randomized clinical trial (RCT) if the study population is carefully defined.9 Most experts feel that surgery can prevent the progression of spinal cord dysfunction and can, in many cases, improve the symptoms of cervical spondylotic myelopathy. It is unclear, however, what the optimal surgical technique might be (ventral versus dorsal), and in up to 30% of cases the clinical outcome is not satisfactory.5 Furthermore, the complication rate for CSM surgery is high (17% in a recent prospective study),10 particularly in patients over 74 years of age,11 which is a growing segment of the US population.12 Lastly, the 5-year re-operation rate following surgery for CSM is nearly 15%.13

Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) is a common disorder involving chronic progressive compression of the cervical spinal cord due to degenerative disc disease, spondylosis, or other degenerative pathology. CSM is the most common form of spinal cord impairment and causes functional decline leading to reduced independence and quality of life. Despite a sound understanding of the disease process, clinical presentation and management, a universal definition of CSM and a standardized index of severity are not currently used universally. Work is required to develop a definition and establish clinical predictors of progression to improve management of CSM. Despite advances in decompressive and reconstructive surgery, patients are often left with residual disability. Gaps in knowledge of the pathobiology of CSM have limited therapeutic advances to complement surgery. Although the histopathologic and pathophysiologic similarities between CSM and traumatic spinal cord injury have long been acknowledged, the unique pathomechanisms of CSM remain unexplored. Increased efforts to elucidate CSM pathobiology could lead to the discovery of novel therapeutic targets for human CSM and other spinal cord diseases. Here, the natural history of CSM, epidemiology, clinical presentation, and current methods of clinical management are reported, along with the current state of basic scientific research in the field.