Treatment Option For Cervical Myelopathy Research Articles

Deformity Considerations in Cervical Laminoplasty: A Narrative Review.

We discuss the incidence of postoperative kyphosis following laminoplasty and its impact on outcomes, as well as critical radiographic parameters, intraoperative technical factors, and postoperative protocols that can be used to improve results. When appropriately selected, cervical laminoplasty is a motion-sparing treatment option for cervical myelopathy and is a valid alternative to laminectomy and fusion procedures. However, like other posterior-based cervical decompression techniques, laminoplasty can cause postoperative kyphosis. A PubMed search was performed to gather articles that focus on cervical deformity in the context of cervical laminoplasty. The reported conversion rates of lordotic to kyphotic cervical alignment after laminoplasty range from 5.2% to 11.3%. Kyphosis likely reduces the benefit from the operation as measured by postoperative mJOA scores. A surgeon can minimize the risk of causing a clinically significant reduction in lordosis by screening out patients with certain radiographic characteristics. Intraoperative decisions such as dissection techniques, levels chosen, and hybrid constructs can preserve the cervical tension band. Certain postoperative protocols can improve cervical posture. Cervical laminoplasty is an effective tool for treating degenerative cervical myelopathy. Careful radiographic screening, intraoperative decision-making, and postoperative protocols can minimize the development of postoperative cervical deformity and improve outcomes. Level V.

Safety profile of multilevel outpatient cervical disc arthroplasty

BackgroundEfforts are underway to shift an increasing number of procedures to outpatient procedures. The literature has demonstrated high rates of safety, cost savings and patient satisfaction for various spine procedures performed in the outpatient setting. Cervical Disc Arthroplasty (CDA) has become an acceptable surgical treatment option for cervical myelopathy and or radiculopathy. While this procedure has been shown to be safe when performed in an inpatient setting, the safety of performing multilevel CDA in the outpatient setting requires careful assessment. Methods and ResultsWe searched the Pubmed database using following search keywords: “cervical disc replacement,” “cervical disc arthroplasty,” “multilevel,” “outpatient,” “ambulatory.” Four retrospective cohort studies and one meta-analysis were identified and relevant to the topic. The literature was critically evaluated. ConclusionMultilevel CDA can be safely performed in the outpatient setting, with lower complication rates, shorter operating times, and similar readmission and reoperation rates compared with inpatient CDA. When choosing to perform this procedure in the ambulatory setting each surgeon should consider their own skill set and familiarity with CDA. While no evidence-based guidelines exist regarding which patients are optimal candidates to perform this procedure on in the outpatient setting, careful patient selection is important. Further prospective randomized studies with larger sample sizes are needed to generate evidence-based protocols for patient selection in order to optimize outcomes and the safety of performing multilevel cervical disc arthroplasty in the outpatient setting. Level of EvidenceV

Cervical Disk Arthroplasty Is an Acceptable Treatment Option for Cervical Myelopathy

Cervical Disk Arthroplasty Is an Acceptable Treatment Option for Cervical Myelopathy

Effectiveness of Riluzole as a pharmacotherapeutic treatment option for early cervical myelopathy: a double-blinded, placebo-controlled randomised controlled trial.

To evaluate the effectiveness of Riluzole as a pharmacotherapeutic treatment option for early cervical myelopathy using clinical parameters and DTI analysis. Early cervical myelopathy cases with MJOA scores ≥13, were recruited for the double-blinded, placebo-controlled randomised control trial. Thirty cases with fifteen cases each in the test and placebo group were studied. Analysis was done using diffusion tensor imaging (DTI) and clinical evaluation, pre- and post-institution of sodium channel blocker Riluzole for a period of 1month (50mg twice daily). Placebo group was treated with Vitamin B complex tablets. Diffusion co-efficient fractional anisotrophy (FA), apparent diffusion co-efficient (ADC), volume ratio (VR), relative anisotrophy (RA) and Eigen vectors were calculated. Outcomes analysis was based on clinical scores of MJOA, Nurick grading, SF-12, NDI, and statistical analysis of DTI datametrics. The mean MJOA score was 15.6 (13-17) with no significant change in the test and control groups. The mean ADC, FA values were 1533.36 (1238-1779) and 494.36 (364-628) and changed to 1531.57 (1312-2091) and 484.86 (294-597), respectively, in the Riluzole group. However, the changes in the values of ADC, FA, and other co-efficients including VR, RA and eigenvectors in the two groups were not statistically significant. The functional scores in the SF-12 and NDI questionnaires did not change significantly. Our study did not show a significant change in the clinical outcome and DTI Indices with the use of Riluzole as a standalone pharmacotherapeutic agent for early cervical myelopathy. More studies may be needed to confirm the usefulness of Riluzole as a treatment option for cervical myelopathy.

Activ C cervical disc replacement for myelopathy

Background:Cervical disc replacement is becoming an increasingly popular treatment option for cervical myelopathy. It retains motion at the affected segment, unlike anterior cervical discectomy and fusion. The aim of this study is to assess the outcomes of a series of patients who underwent Activ C disc replacement for cervical myelopathy.Materials and Methods:A series of patients at the above Trust with clinical and radiological evidence of cervical myelopathy who were suitable for cervical disc replacement from 2007 to 2009 were included. Implants were inserted by one of two consultant surgeons {IMS, MO’M}. Patients were assessed preoperatively and at six, 12 and 24 months, postoperatively, with a visual analogue score (VAS) for neck and arm pain severity and frequency, the Neck Disability Index questionnaire (NDI) and the Centre for Epidemiologic Studies Depression questionnaire (CES-D).Results:Ten patients underwent surgery between May 2007 and July 2009, 6 women, and 4 men. Average age was 54 years (40-64). Disc levels replaced were: four at C4-5; eight at C5-6; seven at C6-7. Three patients had one disc replaced, five patients had two discs replaced, and two patients had three discs replaced. The VAS for neck pain improved from 5.9 pre-operatively to 1.4-24 months postoperatively and the VAS arm pain improved from 5.4 to 2.6. The NDI improved from 51% preoperatively to 26.8% at 24 months postoperatively. The CES-D showed a slight increase from 19.5 preoperatively to 21.7 at 24 months, postoperatively.Conclusion:Cervical decompression and disc replacement improves pain and function in patients with cervical myelopathy. This benefit is maintained at 24 months post op, with no cases requiring revision.

Clinical Features and Surgical Outcomes of Cervical Myelopathy in the Elderly

Treatment of cervical myelopathy in elderly patients is controversial. We retrospectively studied 113 patients who had decompression surgery from 1990-2001 to clarify how pre-operative conditions, duration of symptoms, involved levels, surgical outcomes, and complications differ between younger and elderly patients. We also asked whether elderly patients would likely have reasonable outcomes of surgery. The patients were divided into five age groups: Group 1, 36-45 years (12 patients); Group 2, 46-55 years (22 patients); Group 3, 56-65 years (31 patients); Group 4, 66-75 years (32 patients); and Group 5, 76-85 years (16 patients). The duration of symptoms was similar among the five groups. The involved level was more cephalic in the older groups, and the most frequently involved level in patients older than 75 years was C3-C4. Neurologic symptoms were more severe preoperatively and postoperatively in older patients. The recovery ratio also was lower in older patients; however, in Group 5 it was 36.9%, which indicated that patients older than 75 years could regain approximately 40% of their function postoperatively. Decompression surgery can be a reasonable treatment option for cervical myelopathy, even in elderly patients. Therapeutic Study, Level IV (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Cervical Myelopathy due to Ossification of Yellow Ligament in a Patient with Reiter's Syndrome

Reiter’s syndrome is described as an inflammation of the joints and tendon attachments at the joints, and is often accompanied by an inflammation of the eye’s conjunctiva and the mucous membranes, such as those of the mouth, urinary tract, vagina, and penis, and by a distinctive rash. Ossification of the yellow ligament associated with Reiter’s syndrome has never been reported A 41-year old male patient with Reiter’s syndrome was admitted to our hospital due to cervical myelopathy caused by ossification of yellow ligament. He was treated with laminectomy and fusion, from C3 to C7, by using a lateral mass screw and plate fixation. Laminectomy and fusion seems to be an appropriate treatment option for cervical myelopathy due to ossification of yellow ligament.