Surgical Treatment Of Cervical Myelopathy Research Articles

Three-Dimensional Computed Tomography Image Reformation for Comparison of Foraminal Cross-Sectional Dimension in Patients Who Have Undergone Laminoplasty and Laminectomy with Fusion.

Laminectomy with fusion (LF) is commonly performed with laminoplasty (LP) for cervical myelopathy. Foraminal stenosis is important in the surgical treatment of cervical myelopathy. LF and LP can affect foraminal size in different ways. This study aimed to compare foraminal dimensions after LF and LP using a medical computer-assisted design (CAD) program. Computed tomography (CT) scans of the cervical vertebrae of 16 patients with cervical myelopathy were retrospectively viewed in the Digital Imaging and Communications in Medicine format on a CAD program. CT images were reformatted in an oblique plane perpendicular to the long axis of each foramen from C2-C3 to C6-C7. The narrowest foraminal crosssectional dimension (FCD) was measured and compared between the LF and LP groups at the operated, non-operated, and C4-C5 levels. The difference between the preoperative and postoperative FCDs was also calculated and compared between the operated and C4-C5 levels. Intra- and interobserver reliabilities for FCD measurements were evaluated using intraclass correlation coefficients. At the operated spinal levels, the LF and LP groups showed decreased and increased mean FCDs, respectively. At the adjacent non-operated levels, the mean FCD slightly increased in both the groups. In the LF group, the difference between the preoperative and postoperative FCDs in the C4-C5 levels was larger than that in the other operated levels, but this difference was insignificant. LF and LP showed contrary results for FCD. Therefore, FCD and kyphosis should be considered for LF and LP. three-dimensional, foraminal cross-sectional dimension, laminoplasty, laminectomy fusion, computer-aided design, drafting system, preoperative-postoperative comparison.

A Longer Duration of Myelopathy Symptoms is Associated With the Lack of Intraoperative Motor Evoked Potential Improvement During Decompressive Cervical Myelopathy Surgery.

Retrospective cohort study. We aim to investigate the relationship between the intraoperative motor evoked potential (MEP) signal changes during surgical treatment of cervical myelopathy with postoperative functional outcomes and determine what factors correlate with MEP signal changes. Intraoperative neurophysiologic monitoring with MEP for cervical cord decompression can potentially predict postoperative neurological complications. We prospectively collected data from 114 consecutive cervical compressive myelopathy patients who underwent decompressive cervical spine surgery. Functional outcomes were measured preoperatively and postoperatively at the 6-month mark, using the modified Japanese Orthopedic Association score. Among the 114 patients, 87 patients showed significant MEP improvement, 1 patient with MEP degeneration, 3 patients with no change in MEP, and 23 patients with MEP change, but which eventually returned to baseline. Univariate analysis showed that patients with MEP improvement had similar 6-month functional and Japanese Orthopedic Association scores compared with patients who did not have MEP improvement. Critically, a longer duration of symptoms was shown to have a statistically significant relationship with patients who did not have MEP improvement on univariate analysis (49.2wk in patients with no MEP improvement compared with 34.59wk in patients with MEP improvement, P = 0.03) but this did not translate to differences in functional outcomes. There was also no statistically significant association between the functional outcome scores and demographics, surgical, or radiologic factors. Our study shows that the duration of symptoms is not attributed to lower functional outcomes but is associated with a lack of MEP improvement. Level III.

Patient-Reported Outcomes Following Anterior and Posterior Surgical Approaches for Multilevel Cervical Myelopathy.

Retrospective cohort. To compare health-related quality of life (HRQoL) outcomes between approach techniques for the treatment of multilevel degenerative cervical myelopathy (DCM). Both anterior and posterior approaches for the surgical treatment of cervical myelopathy are successful techniques in the treatment of myelopathy. However, the optimal treatment has yet to be determined, especially for multilevel disease, as the different approaches have separate complication profiles and potentially different impacts on HRQoL metrics. Retrospective review of a prospectively managed single institution database of patient-reported outcome measures after 3 and 4-level anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) for DCM. The electronic medical record was reviewed for patient baseline characteristics and surgical outcomes whereas preoperative radiographs were analyzed for baseline cervical lordosis and sagittal balance. Bivariate and multivariate statistical analyses were performed to compare the two groups. We identified 153 patients treated by ACDF and 43 patients treated by PCDF. Patients in the ACDF cohort were younger (60.1 ± 9.8 vs . 65.8 ± 6.9 yr; P < 0.001), had a lower overall comorbidity burden (Charlson Comorbidity Index: 2.25 ± 1.61 vs . 3.07 ± 1.64; P = 0.002), and were more likely to have a 3-level fusion (79.7% vs . 30.2%; P < 0.001), myeloradiculopathy (42.5% vs . 23.3%; P = 0.034), and cervical kyphosis (25.7% vs . 7.69%; P = 0.027). Patients undergoing an ACDF had significantly more improvement in their neck disability index after surgery (-14.28 vs . -3.02; P = 0.001), and this relationship was maintained on multivariate analysis with PCDF being independently associated with a worse neck disability index (+8.83; P = 0.025). Patients undergoing an ACDF also experienced more improvement in visual analog score neck pain after surgery (-2.94 vs . -1.47; P = 0.025) by bivariate analysis. Our data suggest that patients undergoing an ACDF or PCDF for multilevel DCM have similar outcomes after surgery.

Skip corpectomy in surgical treatment of cervical spondylotic myelopathy

To evaluate the effectiveness and safety of skip corpectomy in surgical treatment of cervical spondylotic myelopathy. The study included 7 patients with cervical myelopathy following extended cervical spine stenosis. All patients underwent skip corpectomy. Clinical examination included degree of neurological disorders according to the modified scale of the Japanese Orthopedic Association (JOA) with assessment of recovery rate and Nurick score, as well as VAS score of pain syndrome. Verification of diagnosis was based on the data of spondylography, magnetic resonance and computed tomography. The indications for surgical treatment were conduction disorders and their spondylotic genesis confirmed by neuroimaging methods. Score of pain syndrome decreased by 2-4 points (mean 3.1) in long-term postoperative period. The JOA, Nurick scores and recovery rate (mean 42.5%) demonstrated significant improvement of neurological status in all patients. In all cases, the follow-up examination confirmed adequate decompression and spinal fusion. Skip corpectomy provides adequate spinal cord decompression in case of extended cervical spine stenosis and minimizes the risk of complications typical for multilevel corpectomy. Recovery rate indicates the effectiveness of this method in surgical treatment of cervical myelopathy caused by multilevel stenosis. However, further studies on sufficient clinical material are needed.

Clinical course of pain intensity in individuals with cerebral palsy: A prognostic systematic review.

To describe the clinical course of pain intensity in individuals with cerebral palsy (CP) resulting from usual care or specific interventions. We conducted an exploratory prognostic systematic review searching electronic databases from inception to 31st December 2021. Evidence from low and moderate risk-of-bias studies was synthesized. We retrieved 2275 citations; 18 studies met the inclusion criteria and 10 were synthesized. The course of pain intensity in children with CP receiving usual care was stable over 15 weeks (χ2 [2] =1.8, p=0.5). Children who received continuous intrathecal baclofen (CITB) reported significant pain intensity reduction (visual analogue scale [VAS]=-4.2 out of 10, 95% confidence interval [CI]=-6.3 to -2.1]) 6 months postinsertion but similar children receiving usual care had no significant change over 6 months (VAS=1.3 out of 10, 95% CI=-1.3 to 3.6). Children receiving botulinum neurotoxin A (BoNT-A) injections had significant decreases in pain after 1 month (numeric rating scale=-6.5, 95% CI=-8.0 to -5.0). Adults with chronic pain receiving usual care reported stable pain intensity over time; pain intensity improved in ambulatory adults exercising and those treated surgically for cervical myelopathy. The course of pain intensity in individuals with CP is unclear. Evidence suggests that children and adults receiving usual care had stable pain intensity over the short or long term. Interventions (CITB and BoNT-A in children and exercise and surgical treatment for cervical myelopathy in adults) had pain intensity reduction. Larger study samples are needed to confirm these results. Pain intensity was stable in children with cerebral palsy (CP) receiving usual care. Adults with CP and chronic pain receiving usual care had stable, persistent pain intensity. Children receiving continuous intrathecal baclofen via pump and botulinum neurotoxin A reported significantly lower pain intensities. Adults with chronic pain and dyskinetic CP and cervical myelopathy reported significantly lower pain intensity with exercise or cervical decompression. Limited high-quality evidence exists describing non-procedural pain changes in individuals with CP.

Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database.

Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors' objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.

Surgical outcomes of cervical myelopathy in patients with athetoid cerebral palsy.

Surgical treatment for cervical myelopathy with athetoid cerebral palsy remains unestablished. Instrumented fusion is reported to have good clinical results; however, there are no data of decompression surgery for this pathology in recent years. This study aimed to assess the surgical outcomes of laminoplasty with or without posterior instrumented fusion for cervical myelopathy in patients with athetoid cerebral palsy. A multi-centre surgical series of patients with cervical myelopathy and athetoid cerebral palsy were enrolled in this study. All patients showed symptoms and signs suggestive of cervical myelopathy and underwent laminoplasty with or without instrumented fusion. The Japanese Orthopaedic Association (JOA) score, Barthel index (BI), and changes in the C2-C7 sagittal Cobb angle in the lateral plain radiograph were analysed. There were 25 patients (16 men and 9 women; mean age, 54.4 ± 10.8years) with cervical myelopathy and athetoid cerebral palsy who underwent surgical treatment. The mean follow-up period was 41.9 ± 35.6months. Overall, the BI significantly improved after surgery, whereas the JOA score and C2-C7 angle did not improve postoperatively. The recovery rate of the JOA score in the laminoplasty group was significantly higher than that of the fusion group (P = 0.02). Cervical laminoplasty with or without instrumented fusion for treating cervical myelopathy due to athetoid cerebral palsy is effective in improving activities of daily living. Cervical laminoplasty may be an effective and less invasive surgical method for selective patients, especially for those with small involuntary movements and no remarkable cervical kyphosis nor instability.

“Only Spinal Fixation” as Surgical Treatment of Cervical Myelopathy Related to Ossified Posterior Longitudinal Ligament: Review of 52 Cases

Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition resulting in a progressive narrowing of the spinal canal and subsequent neurologic deficits. Although systemic and local factors in combination with genetic abnormality have been considered in its etiopathogenesis, OPLL remains a poorly understood pathology. Surgical management of OPLL and the choice of the most appropriate treatment are stillcontroversial issues. Here the authors report a series of OPLL-affected patients treated by "only-fixation" technique. Between June 2012 and June 2019, 52 patients having OPLL were treated by a surgical strategy involving only spinal fixation without any form of bone or soft tissue decompression. Facetal fixation for both the atlantoaxial and subaxial spine formed the basis of the surgical treatment. Clinical parameters, analysis of video recordings before and after surgery, and patient self-assessment were included in the analysis of outcome. During the mean follow-up period there was an immediate postoperative and progressive recovery in symptoms in 51 patients. Of 14 patients who were wheelchair bound before surgery, 12 walked independently on follow-up assessment of 6 months. All patients had successful arthrodesis in the surgically treated segments. There were no infective- or implant-related complications. Decision making in the surgical management of cervical OPLL is still controversial. The concept of spinal instability has been shown to be a nodal point in the pathogenesis of OPLL, and "only-spinal fixation" can be considered a rationale for an appropriate surgical treatment.

Quality of life indicators in assessing the results of various surgical treatment methods for cervical myelopathy

Quality of life indicators are widely used to determine the efficiency of various medical therapies for cervical myelopathy; however, but these have been insufficiently studied in assessing the results of surgical treatment for this pathology. In addition, the results of surgical treatment for cervical myelopathy are observed to be unsatisfactory in 15–20% of cases, which indicates the need to develop new techniques and to improve existing ones for its correction. Direct electrical stimulation of the spinal cord may become one of the promising areas. Objective: to comparatively analyze the efficiency of various surgical treatments for cervical myelopathy, by assessing the quality of life indicators in the patients. Patients and methods. The investigation enrolled 92 patients with cervical myelopathy: 29 (49.2%) patients underwent posterior spinal cord decompression via laminectomy; in 17 of them, that was supplemented with the electrodes placed on the posterior columns of the spinal cord for its postoperative direct electrical stimulation; 63 (50.8%) patients underwent anterior spinal cord decompression, 12 of them had electrodes placed on the anterior horns of the spinal cord. Results and discussion. After posterior spinal cord decompression with laminectomy, there were increases in physical functioning from 36.7±2.1 to 49.6±3.1 arbitrary units (arb. unit) (p<0.05) and in role physical functioning from 39.4±2.6 to 51.3±2.6 arb. unit (p<0.05) and a decrease in pain sensations from 51.6±2.6 to 30.2±0.8 arb. unit (p<0.05). Electric stimulation of the spinal cord caused increases in physical functioning from 40.3±3.6 to 61.3±2.8 arb. unit (p<0.05) and in role physical functioning from 36.7±1.6 to 69.4±1.6 arb. unit (p<0.05) and a reduction in pain sensations from 49.8±2.4 to 21.0±1.2 arb. unit (p<0.05). The similar trend as also observed in anterior spinal cord decompression concurrent with corporodesis at the cervical level after direct electrical stimulation of the spinal cord. Physical functioning increased from 42.0±3.1 to 57.6±1.4 arb. unit (by 26.4%; p<0.05) and mental health improved (only by 14.3%). After isolated anterior spinal cord decompression with corporodesis, physical functioning was 48.4±0.9 arb. unit by the end of the third month follow-up (p<0.05); following that in combination with electrical stimulation, physical functioning was 57.6±1.4 arb. unit (p<0.05). The posttreatment levels of viability, social functioning, role emotional functioning, and mental health were significantly lower in patients with a disease duration of more than 6 years than in those with that of less than 3 years. Conclusion. Posterior and anterior spinal cord decompression with laminectomy for cervical myelopathy increases the indicators of physical functioning and role physical functioning and reduces pain sensations. The additional use of electrical stimulation of the spinal cord allows one to increase role physical functioning.

A comprehensive finite element model of surgical treatment for cervical myelopathy

BackgroundCervical myelopathy is a common and debilitating chronic spinal cord dysfunction. Treatment includes anterior and/or posterior surgical intervention to decompress the spinal cord and stabilize the spine, but no consensus has been made as to the preferable surgical intervention. The objective of this study was to develop an finite element model of the healthy and myelopathic C2-T1 cervical spine and common anterior and posterior decompression techniques to determine how spinal cord stress and strain is altered in healthy and diseased states. MethodsA finite element model of the C2-T1 cervical spine, spinal cord, pia, dura, cerebral spinal fluid, and neural ligaments was developed and validated against in vivo human displacement data. To model cervical myelopathy, disc herniation and osteophytes were created at the C4-C6 levels. Three common surgical interventions were then incorporated at these levels. FindingsThe finite element model accurately predicted healthy and myelopathic spinal cord displacement compared to motions observed in vivo. Spinal cord strain increased during extension in the cervical myelopathy finite element model. All surgical techniques affected spinal cord stress and strain. Specifically, adjacent levels had increased stress and strain, especially in the anterior cervical discectomy and fusion case. InterpretationsThis model is the first biomechanically validated, finite element model of the healthy and myelopathic C2-T1 cervical spine and spinal cord which predicts spinal cord displacement, stress, and strain during physiologic motion. Our findings show surgical intervention can cause increased strain in the adjacent levels of the spinal cord which is particularly worse following anterior cervical discectomy and fusion.

Radiographic Fusion Rates Following a Stand-alone Interbody Cage Versus an Anterior Plate Construct for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

Case-control. The aim of this study was to evaluate fusion rates and compare a stand-alone cage construct with an anterior-plate construct in the setting revision anterior cervical discectomy and fusion (ACDF) for adjacent segment disease. Anterior cervical discectomy and fusion are considered the criterion standard of surgical treatment for cervical myelopathy and radiculopathy. One common consequence is adjacent segment disease. Treatment of adjacent segment disease is complicated by the previous surgical implants, which may make application of an additional anterior cervical plate difficult. Stand-alone cage constructs obviate the need for removal or revision of prior implants in the setting of adjacent segment disease. All patients undergoing surgery for adjacent segment disease in a 2-year period were identified and separated into groups based on implant construct. A control group of patients undergoing primary, single-level ACDF were selected from during the same 2-year period. Demographic variables, fusion rate, and reoperation rate were compared between groups. Continuous variables were compared using Student t test, fusion, and revision rates were compared using Pearson χ test. Patients undergoing primary ACDF had lower age and American Society of Anesthesia score as well as shorter operative time. Fusion rate was higher for primary ACDF compared to all patients who underwent ACDF for adjacent segment disease (95% vs. 74%). When compared to primary ACDF, patients with a stand-alone cage construct had significantly lower fusion rate (69% vs. 95%) and higher reoperation rate (14% vs. 0%). There were no significant differences in anterior plate construct versus stand-alone cage construct in terms of fusion and reoperation. Symptomatic adjacent segment disease can be managed surgically with either revision anterior plating or a stand-alone cage constructs, although our results raise questions regarding a difference in fusion rates that requires further investigation. 3.

Prognosis of cervical myelopathy based on diffusion tensor imaging with artificial intelligence methods.

Diffusion tensor imaging (DTI) has been proposed for the prognosis of cervical myelopathy (CM), but the manual analysis of DTI features is complicated and time consuming. This study evaluated the potential of artificial intelligence (AI) methods in the analysis of DTI for the prognosis of CM. Seventy-five patients who underwent surgical treatment for CM were recruited for DTI imaging and were divided into two groups based on their one-year follow-up recovery. The DTI features of fractional anisotropy, axial diffusivity, radial diffusivity, and mean diffusivity were extracted from DTI maps of all cervical levels. Conventional AI models using logistic regression (LR), k-nearest neighbors (KNN), and a radial basis function kernel support vector machine (RBF-SVM) were built using these DTI features. In addition, a deep learning model was applied to the DTI maps. Their performances were compared using 50 repeated 10-fold cross-validations. The accuracy of the classifications reached 74.2%±1.6% for LR, 85.6%±1.4% for KNN, 89.7%±1.6% for RBF-SVM, and 59.2%±3.8% for the deep leaning model. The RBF-SVM algorithm achieved the best accuracy, with sensitivity and specificity of 85.0%±3.4% and 92.4%±1.9% respectively. This finding indicates that AI methods are feasible and effective for DTI analysis for the prognosis of CM.

Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 117. Psychiatric diagnosis impacts outcomes in surgical treatment of cervical myelopathy

BACKGROUND CONTEXT Cervical myelopathy is a common disorder of the spine caused by numerous disease processes and is often treated surgically. Psychiatric diagnoses are known to impact outcomes of surgical procedures; however, the impact of psychiatric disorders on postoperative outcomes for the diagnosis of cervical myelopathy is not well understood. PURPOSE The purpose of this study was to assess the impact of psychiatric comorbidities on postoperative outcomes in patients undergoing surgical treatment for cervical myelopathy. STUDY DESIGN/SETTING This was a retrospective cohort analysis performed on a national database using a 20% stratified sample of discharges from United States hospitals. This database did not include rehabilitation and long-term acute care facilities and is the largest publicly available inpatient, all-payer database in the U.S. PATIENT SAMPLE The Healthcare Cost and Utilization Project National Inpatient Sample database 2013-2014 was queried for hospitalizations with a diagnosis of cervical myelopathy based on International Classification of Diseases ninth revision clinical modification (ICD-9-CM) code 721.1. The analysis included only those undergoing a procedure. OUTCOME MEASURES Primary outcomes queried were relevant complications listed in the NIS, overall complication rate, discharge disposition, length of stay, mortality and total hospital charges. METHODS Descriptive statistics were used to characterize cases with psychiatric comorbidities versus those without. Demographic data was compared using Chi-square and Student's t-test and multivariate analysis was used to identify the impact of a psychiatric diagnosis for various outcomes. RESULTS A total of 24,142 hospitalizations met the inclusion criteria. Of these, 1,002 (4.2%) had a diagnosed psychiatric disorder. Hospitalizations with a psychiatric comorbidity tended to be younger (58.9 vs. 62.0, p CONCLUSIONS Patients with psychiatric comorbidities undergoing surgical treatment for cervical myelopathy have an increased risk of nonhome discharge, a longer length of hospital stay, but no increased risk of postoperative complications or mortality, nor any significant difference in total hospital charges. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P112. Treatment of mild cervical myelopathy: which factors predict the decision for surgical intervention?

BACKGROUND CONTEXT Surgical treatment of cervical myelopathy is associated with improved outcomes in patients across all stages of disease severity. However, a trial of supervised rehabilitation is recommended as an alternative to surgical treatment for patients with mild cervical myelopathy (Modified Japanese Orthopaedic Association (MJOA) scale score ≥15). PURPOSE The purpose of this study was to evaluate which factors predicted selection for surgical intervention in patients with mild cervical myelopathy. METHODS Patients with cervical myelopathy from seven Canadian centers were prospectively enrolled in the Canadian Spine Outcomes Research Network (CSORN) database. Demographic, clinical, radiographic, and health related quality of life (HRQOL) data was collected on all patients for baseline data. Multivariate logistic regression modeling was used to identify predictors of surgical intervention. RESULTS Three hundred sixty patients were enrolled, of which 96 patients were categorized as mild myelopathy. Eighty-three (86.4%) were treated surgically and 13 (13.6%) were treated conservatively. Sixty of those with mild myelopathy (62.5%) were male and the mean age was 55.7 (SD 12.6) years old. There were no differences between surgical and nonsurgical patients with respect to BMI, duration of symptoms, medical comorbidities and age. MJOA scores were higher in the nonoperative group (17.0 SD 0.89vs. 15.0 SD 0.93, p=.002). Patients who underwent surgery had higher baseline neck pain (5.18vs. 4.53) and higher disability (NDI) (35.03vs. 33.87) scores which did not reach statistical significance. There was no difference between groups for any radiographic parameters including spinal cord compression, spine alignment, and cord signal change. Multivariate analysis revealed that the selection of patients for surgical intervention was predicted by symptoms of less than one year duration, higher neck pain scores, lower quality of life scores (EQ5D), and higher disability (NDI) scores. CONCLUSIONS Patients who were treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to demographic or radiographic parameters. After adjusted analysis patients were more likely to have surgical intervention if duration of symptoms was shorter and they had worse pain and quality of life scores.

Prediction of Outcome Following Surgical Treatment of Cervical Myelopathy Based on Features of Ossification of the Posterior Longitudinal Ligament

Ossification of the posterior longitudinal ligament (OPLL) is defined as ectopic bone formation within the posterior longitudinal ligament. Although various OPLL features (including the extent, shape, and thickness of the OPLL as well as the presence of dural ossification) have been defined in the literature, we are not aware of any systematic reviews that have summarized the associations between these features and clinical outcomes following surgery. The objective of the present study was to conduct a systematic review of the literature to determine whether OPLL characteristics are predictive of outcome in patients undergoing surgery for the treatment of cervical myelopathy. An extensive search was performed using 4 electronic databases: MEDLINE, MEDLINE In-Process, Embase, and the Cochrane Central Register of Controlled Trials. Our search terms were OPLL and cervical. We identified studies in English or Japanese that evaluated the association between cervical OPLL features and surgical outcome. The overall body of evidence was assessed with use of a scoring system developed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group with recommendations from the Agency for Healthcare Research and Quality (AHQR). The present systematic literature review is formatted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search yielded a total of 2,318 citations. A total of 28 prognostic cohort studies were deemed relevant following a rigorous review process. Among them, only 7 retrospective studies involved a multivariate analysis that controlled for potential confounding variables. Sample sizes ranged from 47 to 133 patients. The main outcome was the postoperative Japanese Orthopaedic Association (JOA) score and/or recovery rate in 6 studies and the Nurick grade in 1. Of these, 2 were rated as Level-II evidence and 5 were rated as Level-III evidence. On the basis of our results, there was low evidence that patients with a hill-shaped ossification have a worse postoperative JOA score following laminoplasty than those with a plateau-shaped lesion; low evidence that the space available for the spinal cord cannot predict postoperative JOA scores; moderate evidence that there is no association between the occupying ratio and improvement on the Nurick scale; and insufficient evidence to determine the association between JOA outcomes and the type of OPLL, the presence of dural ossification, and the occupying ratio. Patients with hill-shaped OPLL have a worse postoperative JOA score than those with plateau-shaped ossification after laminoplasty. Because of limited evidence, it is unclear whether the occupying ratio, the type of OPLL, and the presence of dural ossification are predictive of surgical outcomes following either anterior or posterior decompression. A limited number of studies have used a multivariate analysis to evaluate the association between clinical outcomes and OPLL features. Additional studies representing high-quality evidence are needed. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of outcomes of surgical treatment for degenerative diseases of the spine

The paper presents a review of the current literature devoted to estimation of outcomes of surgical treatment for degenerative changes in the spine using scales, tests and questionnaires. The literature search in domestic and foreign bibliographic databases has been carried out, and the use of scales, tests and questionnaires in spinal surgery was analyzed. The review presents requirements for scales, tests and questionnaires, examines the evaluation of clinical and patient-reported outcomes, and describes the advantages of multifactorial outcome evaluation. The multifactorial evaluation of outcomes is illustrated by the example of degenerative changes in the cervical spine, and includes a clinical case of surgical treatment for cervical myelopathy. The limitations of scales, tests and questionnaires are also discussed.

Perioperative malnutrition and its relationship to length of stay and complications in patients undergoing surgery for cervical myelopathy.

Background:Surgical treatment of cervical myelopathy is common, and the impact of perioperative malnutrition in these patients is unclear; yet, malnutrition pre- and postoperatively has been associated with higher rates of wound infection in spine patients. We evaluated the association of low prealbumin level, a marker for poor nutrition, with length of hospitalization and complication rates after surgery for cervical myelopathy.Methods:We retrospectively identified patients with cervical myelopathy who underwent anterior cervical discectomy and fusion, anterior cervical corpectomy and fusion, or posterior cervical decompression and fusion over a 5-year period. Patients’ prealbumin levels were measured within 4 days of surgery; they were divided into low and normal groups (threshold 15 mg/dL). Demographic, clinical, operative, and postoperative parameters were correlated with prealbumin levels by utilizing univariate and multivariable analyses.Results:Eighteen patients were in the “low prealbumin” group and 37 were in the “normal prealbumin” group. Patients with low prealbumin were significantly more likely to have an extended length of hospitalization/stay (LOS) (median 6 days, interquartile range 7.5 days vs. median 3 days, interquartile range 2 days, P < 0.001) and more postoperative complications (33% versus 0%, P < 0.001). Multivariable analysis revealed that only the low prealbumin category (P < 0.001) was associated with a prolonged LOS.Conclusions:Low prealbumin levels were associated with prolonged LOS after surgery for cervical myelopathy. We need to better define the effects of malnutrition in patients with cervical myelopathy in the future.

6 - The Effect of Smoking on Spinal Cord Healing following Surgical Treatment for Cervical Myelopathy

BACKGROUND CONTEXT: The harmful effects of smoking on healing have been well established. However, there is scant data regarding the effect of smoking on postoperative outcomes for cervical myelopathy.

Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy

ObjectiveThe aim is to demonstrate whether there is clinical difference between posterior vs anterior decompression in cervical spondylotic myelopathy. MethodsForty-two patient database was obtained from the Centro Medico Nacional de Occidente in Mexico, those who underwent surgical treatment for cervical myelopathy with a mean 1.4 year follow-up. ResultsPatients were divided; group A (45%) anterior approach and group B (55%) posterior approach, for mJOA, group A had a lower score compare with group B. While in the Nurick score group B got a higher score compare with group A. ConclusionsPosterior decompression resulted in better functional outcomes (p<0.05).

The Effect of Smoking on Spinal Cord Healing Following Surgical Treatment of Cervical Myelopathy.

Retrospective cohort. The purpose of this study was to compare outcomes of surgical treatment of cervical myelopathy between smokers and nonsmokers as assessed by the Nurick score. The harmful effects of smoking on healing have been well established. However, the effect of smoking on postoperative outcomes for cervical myelopathy has not been specifically evaluated. The medical records of 212 patients who underwent surgery for cervical spondylotic myelopathy were reviewed. Inclusion criteria were the diagnosis of cervical spondylotic myelopathy with a Nurick score, surgical intervention, and at least 2 years of follow-up. The patients were categorized into 2 groups according to smoking status and stratified according to pack years and packs per day. Age at presentation, sex, preoperative and postoperative Nurick score, duration of symptoms preoperatively, duration of follow-up, procedure performed, surgical approach, number of levels fused, diabetes status, cocaine use, ethanol use, preoperative magnetic resonance imaging signal change, and whether the patient belonged to the Veterans Administration (VA) were recorded. Analysis was done using simple linear regression and multiple regression. Univariate analysis demonstrated a postoperative improvement in nonsmokers of 1.53 points on the Nurick scale compared with 0.6 points in smokers (P < 0.001). There is a progressive decrease in improvement as the number of pack years and packs per day increase (P < 0.001). There is a greater improvement in Nurick score with greater (worse) preoperative score but only in patients with fewer than 25 pack years. Smoking status is not associated with preoperative Nurick score. Smoking status is associated with poor improvement in Nurick score after surgical treatment of cervical myelopathy. Smoking may have a directly toxic effect on the intrinsic healing capability of the spinal cord, particularly beyond 25 pack years. 3.