Prognosis Of Myelopathy Research Articles

Myelopathy associated with mixed connective tissue disease: clinical manifestation, diagnosis, treatment, and prognosis.

Mixed connective tissue disease (MCTD) is a chronic autoimmune disease, which has a broad range of clinical manifestations shared by systemic lupus erythematosus, systemic sclerosis, polymyositis/dermatomyositis, and rheumatoid arthritis. MCTD is featured with high serum titers of anti-ribonucleoprotein antibodies and multiple system involvement. Its spinal cord involvement mainly manifests as transverse myelopathy (TM) and longitudinal extensive transverse myelopathy (LETM). Myelopathy in MCTD is extremely rare, and is usually characterized by serious neurological complications, such as paralysis or muscular paresis, sensory impairment, and smooth muscle dysfunction. Progressive clinical manifestations combined with laboratory examinations and magnetic resonance imaging examinations play important roles in the diagnosis of this disease. In order to prevent permanent neurological damage to the spinal cord, plasmapheresis and intravenous immunoglobulin can be performed in patients at the early disease stage. Early high-dose corticosteroids combined with cyclophosphamide, followed by low doses of immunosuppressors, can improve the long-term prognosis of patients. There are only nine global cases reported on MCTD associated with myelopathy at present. The death rate and disability rate of myelopathy in MCTD are extremely high. In this review, the pathomechanisms, clinical manifestations, auxiliary examination, diagnosis, differential diagnosis, treatment, and prognosis of myelopathy in MCTD were systematically elucidated.

Outcome and Prognosis of Myelopathy and Radiculopathy From Osteochondroma in the Mobile Spine

A retrospective study of 14 spinal osteochondroma (OC) patients with compressive myelopathy or radiculopathy who underwent excision of the lesions. To evaluate the surgical results of a series of cases of symptomatic OCs and the risk of recurrence and malignant transformation in the mobile spine. Intraspinal OC with symptomatic spinal cord or nerve root compression is a rare disease. Most of the lesions require surgical treatment. However, some patients may relapse or malignant transformation may occur after surgery. Fourteen symptomatic spinal OC cases, including 2 hereditary multiple exostoses, were treated surgically from 2001 to 2010. The clinical history, plain radiographs, computed tomography, magnetic resonance imaging, pathologic characteristics, surgical treatments, and outcomes were reviewed. All the patients were followed up for an average of 48.9 months. The 14 patients included 8 with lesions in the cervical spine, 3 with lesions in the thoracic spine, and 2 with lesions in the lumbar spine. One patient had a particularly large lesion which extended from C7 to T6. The OCs originated from the lamina (4), lateral mass (3), vertebral body (3), processus transversus (1), spinous process (1), pedicle of vertebral arch (1), and an indeterminate location (1). Six patients presented with myelopathy from spinal cord compression and 8 with radiculopathy from nerve root compression. Operative approaches included posterior (11) and combined posterior anterior (3) patients. The surgical outcome was satisfactory in 79% (11) of patients. Two recurrent lesions were notable for sarcomatous transformation. We recommend gross total resection of all diagnosed OCs involving the mobile spine because of the risk of malignant transformation. Early detection and total excision of symptomatic spinal lesions in these cases may be the key to providing the best outcome. The neurological defect arising from OC can be improved by surgical intervention in most patients.

Value of somatosensory evoked potentials in diagnosis, surgical monitoring and prognosis of cervical spondylotic myelopathy

The value of somatosensory evoked potentials (SEPs) in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated. Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups: Type I, II, III and IV. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed. According to the configurations of the SEPs, there were 27 patients (36%) of Type I, 30 patients (39%) of Type II, 8 patients (11%) of Type III, and 11 patients (14%) of Type IV. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy (P<0.01) and the recovery rate from identifiable SEPs waves (groups A, B and C) was significantly higher than unidentifiable waves (group D, P<0.01). A deterioration of SEPs was detected in 23 cases (30%), whereas there was no change in 40 cases (53%) and improvements in 13 cases (17%). A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups. SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.

Prognostic Value of Somatosensory-Evoked Potentials in the Surgical Management of Cervical Spondylotic Myelopathy

Preoperative somatosensory-evoked potentials (SEPs) were retrospectively analyzed and classified, and compared with surgical outcome. To evaluate the value of the preoperative SEP waveform in predicting the clinical outcome after surgical management of cervical spondylotic myelopathy (CSM). SEPs have played an important role in spinal surgery. However, the value of SEPs in predicting the outcome of surgery for CSM remains controversial. This study enrolled 76 CSM patients who underwent surgical intervention. Median nerve SEPs were recorded before surgery. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurologic function before surgery and at postoperative follow-up at 1, 3, 6, 12, and 24 months. Patients were divided into 5 groups according to the classification of their preoperative SEP waveforms. Group I patients had normal SEPs, group IIa had normal latency and abnormal amplitude, group IIb had abnormal latency and normal amplitude, group III had abnormal latency and amplitude, and group IV had immeasurable waveforms. The myelopathic disability scores and surgical outcomes in different groups were compared by the Kruskal-Wallis test. The SEP classification was found to be significantly associated with the JOA score (Pearson's chi test, chi = 53.9, P < 0.05). There were no significant differences in JOA score recovery at different follow-up times within any SEP group. At 24 months after surgery, there was no significant difference in the recovery ratio between groups I and IIa, or between groups IIb and III (Kruskal-Wallis test, P > 0.05). However, the recovery ratio was significantly higher in groups I and IIa than in all the other groups (Kruskal-Wallis test, P < 0.05), and in groups IIb and III than in group IV (Kruskal-Wallis test, P < 0.05). SEP classification correlates well with CSM disability and postoperative recovery ratio. Median nerve SEP recordings would be a valuable and practical tool for the diagnosis and prognosis of myelopathy.