scholarly journals N-acetylaspartate in the motor and sensory cortices following functional recovery after surgery for cervical spondylotic myelopathy

2016 ◽  
Vol 25 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Sandy Goncalves ◽  
Todd K. Stevens ◽  
Patricia Doyle-Pettypiece ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylotic Myelopathy ◽  
Time Course ◽  
Spinal Injury ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Neurological Recovery ◽  
Decompression Surgery ◽  
Control Subjects ◽  
Sensory Cortices

OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of reversible spinal cord dysfunction in people over the age of 55 years. Following surgery for symptomatic CSM, patients demonstrate motor improvement early in the postoperative course, whereas sensory improvement can lag behind. The authors of the present study hypothesized that changes in the concentration of N-acetylaspartate (NAA) in the motor and sensory cortices in the brain would emulate the time course of neurological recovery following decompression surgery for CSM. Their aim was to compare and contrast how metabolite levels in the motor and sensory cortices change after surgery to reverse downstream spinal cord compression. METHODS Twenty-four patients with CSM and 8 control subjects were studied using proton MR spectroscopy (1H-MRS) images acquired on a 3.0-T Siemens MRI unit. The 1H-MRS data (TE 135 msec, TR 2000 msec) were acquired to measure absolute levels of NAA from the motor and sensory cortices in the cerebral hemisphere contralateral to the side of greater deficit at baseline in each subject. Data were also acquired at 6 weeks and 6 months following surgery. Control subjects were also evaluated at 6 weeks and 6 months following baseline data acquisition. Neurological function was measured in each subject at all time points using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) questionnaire, and the American Spinal Injury Association (ASIA) neurological classification. RESULTS In the motor cortex of patients, NAA levels decreased significantly (p < 0.05) at 6 weeks and 6 months postsurgery compared with baseline levels. In the sensory cortex of patients, NAA levels decreased significantly (p < 0.05) only at 6 months after surgery compared with baseline and 6-week levels. No significant changes in NAA were found in control subjects. Clinical scores demonstrated significant (p < 0.05) motor recovery by 6 weeks, whereas sensory improvements (p < 0.05) appeared at only 6 months. CONCLUSIONS Findings suggest that metabolite changes in both the motor and sensory cortices mimic the time course of functional motor and sensory recovery in patients with CSM. The temporal course of neurological recovery may be influenced by metabolic changes in respective cortical regions.

scholarly journals Treatment of Cervical Myelopathy with Acupotomy Combined with Korean Medicine Treatments: Two Clinical Cases

2021 ◽  
Vol 38 (1) ◽  
pp. 79-84
Author(s):  
Yu-Kyeong Park ◽  
Sangha Woo ◽  
Jae Hoon Kim ◽  
Jung Hee Lee ◽  
Yun-Kyu Lee ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Spinal Injury ◽  
Japanese Orthopaedic Association ◽  
Evaluation Criteria ◽  
Analog Scale ◽  
Korean Medicine ◽  
Cord Injury

The degenerative spinal cord disease cervical spondylotic myelopathy (CSM), and cervical myelopathy caused by trauma, can result in debilitating symptoms affecting quality of life. This study used acupotomy and other Korean medicine treatments (acupuncture, herbal medicine, and physical therapy) to improve the symptoms of CSM and cervical myelopathy. The visual analog scale, the modified Japanese Orthopaedic Association scale (mJOA scale), the Nurick grading system, and the American Spinal Injury Association impairment scale were used as the evaluation criteria to determine the effectiveness of treatment. The functional status of both patients improved from mild to moderate, with improved gait, local sensation, and level of pain. The degree of spinal cord injury remained the same. The findings of this study suggest that combined Korean medicine treatments including acupotomy may be helpful in the treatment of CSM and cervical myelopathy.

scholarly journals Anterior Controllable Antedisplacement and Fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS): a retrospective study of 45 cases

2019 ◽  
Author(s):  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
Shunmin Wang ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Significant Difference ◽  
Csf Leakage ◽  
One Year ◽  
Neck Disability ◽  
Multilevel Cervical Spondylotic Myelopathy

Abstract Background To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), and compare ACAF with hybrid decompression fixation (HDF). Methods A retrospective analysis of 85 cases with MCSMSS was carried out. 45 patients were treated with ACAF, while 40 patients were treated with HDF. The operation time, intraoperative bleeding volume, postoperative complications, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, Computed Tomography (CT) transverse measurement, cervical curvature and Kang's grade were compared between two groups. Results The patients were followed up for 12 to 17 months. Compared with HDF, ACAF group achieved better decompression according to CT measurement and Kang’s grade (P < 0.05), and recovered to a greater cervical Cobb’s angle (P < 0.05). However, JOA score and NDI index showed no significant difference one year after surgery (P＞0.05). Additionally, ACAF presented longer operation time and greater intraoperative blood loss (P < 0.05). As to complications, ACAF developed less incidences of cerebrospinal fluid examination (CSF) leakage, neurologic deterioration, epidural hematoma and C5 palsy by comparing with HDF. Conclusions ACAF is an effective method for the treatment of MCSMSS. Compared with HDF, ACAF has the advantages of significant decompression, increasing cervical curvature, and reducing the incidences of complications.

scholarly journals Myelopathic signs and functional outcome following cervical decompression surgery: a proposed myelopathy scale

2016 ◽  
Vol 24 (6) ◽  
pp. 871-877 ◽  
Author(s):  
Salem El-Zuway ◽  
Forough Farrokhyar ◽  
Edward Kachur
Keyword(s):  
Functional Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Inverse Correlation ◽  
Decompression Surgery ◽  
Surgery Patient ◽  
Functional Outcome Measures ◽  
Spinal Cord Dysfunction ◽  
The Impact ◽  
Spearman’S Correlation

OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. In spite of this, the impact of the changes in myelopathic signs following cervical decompression surgery and their relationship to functional outcome measures remains unclear. The main goals of our study were to prospectively assess changes in myelopathic signs with a functional outcome scale (the modified Japanese Orthopaedic Association [mJOA] scale) following cervical decompression surgery and to objectively test a proposed new myelopathy scale (MS). METHODS Between 2008 and 2011, 36 patients with CSM were observed following cervical decompression surgery. Patient data including mJOA and MS scores were prospectively collected and analyzed preoperatively and at 1 year after surgery. RESULTS In this cohort, reflex, Babinski, and proprioception signs showed statistically significant improvement following surgery at 1 year (p = < 0.001, p = 0.008, and p = 0.015, respectively). A lesser degree of improvement was observed with the Hoffman sign (p = 0.091). No statistically significant improvement in clonus occurred (p = 0.368). There was a significant improvement in mJOA (p ≤ 0.001) and MS (p ≤ 0.001) scores at 1 year compared with the preoperative scores. The results showed an inverse correlation between MS and mJOA scores both pre- and postoperatively (Spearman's correlation coefficient = −0.202 preoperatively and −0.361 postoperatively). CONCLUSIONS Improvement in myelopathic signs was noted following cervical decompression surgery in patients with CSM. The newly devised MS scale demonstrated these findings, and the new MS scale correlates with improvement in mJOA scores in this patient cohort.

Diabetes Does Not Adversely Affect Neurological Recovery and Reduction of Neck Pain After Posterior Decompression Surgery for Cervical Spondylotic Myelopathy

Spine ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Satoshi Nori ◽  
Narihito Nagoshi ◽  
Kenji Yoshioka ◽  
Kenya Nojiri ◽  
Yuichiro Takahashi ◽  
...  
Keyword(s):  
Neck Pain ◽  
Cervical Spondylotic Myelopathy ◽  
Neurological Recovery ◽  
Decompression Surgery ◽  
Posterior Decompression

Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 708-714 ◽  
Author(s):  
William J. Readdy ◽  
Rajiv Saigal ◽  
William D. Whetstone ◽  
Anthony N. Mefford ◽  
Adam R. Ferguson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Patient Population ◽  
Spinal Injury ◽  
Neurological Recovery ◽  
American Spinal Injury Association ◽  
Neurological Improvement ◽  
Cord Injury

Abstract BACKGROUND: Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population. OBJECTIVE: To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs. METHODS: We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI. RESULTS: In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications. CONCLUSION: Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

scholarly journals Two Types of Laminoplasty for Cervical Spondylotic Myelopathy at Multiple Levels

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Shigeru Hirabayashi ◽  
Takashi Matsushita
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylotic Myelopathy ◽  
Spinal Canal Stenosis ◽  
Decompression Surgery ◽  
Pathological Changes ◽  
Posterior Decompression ◽  
Element Analysis ◽  
Pathological Analysis ◽  
Canal Stenosis ◽  
Multiple Levels

Based on the results from pathological analysis and computer simulations by means of finite element analysis that were reported before, the pathological changes of cervical spondylotic myelopathy (CSM) seem to begin at the posterolateral parts of the spinal cord, because the mechanical stress is mainly concentrated in these parts. With progression of the compression, the pathological changes become distributed to a wider area of the spinal cord. In patients with spinal canal stenosis, these changes spread to multiple levels of the cervical spine. Therefore, posterior decompression surgery at multiple levels such as cervical laminoplasty is thought to be reasonable.

scholarly journals Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

2021 ◽  
Vol 64 (5) ◽  
pp. 808-817
Author(s):  
Hyung Cheol Kim ◽  
Hyeongseok Jeon ◽  
Yeong Ha Jeong ◽  
Sangman Park ◽  
Seong Bae An ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Adjacent Segment ◽  
Factors Affecting ◽  
Cervical Surgery

Objective : Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP.Methods : Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained preand postoperatively and compared between those with and without postoperative complications.Results : Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications.Conclusion : The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.

scholarly journals Comparison of anterior and posterior surgical approaches in multi-level cervical spondylotic myelopathy

2021 ◽  
Vol 8 (8) ◽  
pp. 2371
Author(s):  
Paruvakkattil Kunjan Balakrishnan ◽  
Tinu R. Abraham ◽  
Ajax John
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylotic Myelopathy ◽  
Anterior Approach ◽  
Surgical Approaches ◽  
Decompression Surgery ◽  
Japanese Orthopedic Association ◽  
Spinal Cord Level ◽  
Multi Level ◽  
Multilevel Cervical Spondylotic Myelopathy ◽  
Operative Assessment

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord which occurs due to degenerative changes in cervical spine disc and facet joints. The management of multilevel spondylotic myelopathy is always controversial. The posterior approaches are always preferable in multiple level spondylosis. But according to newer studies, anterior approaches have similar results. Aim of the study was to compare the efficacy of posterior and anterior approaches in multilevel cervical myelopathy.Methods: This study includes all patients with multilevel cervical spondylotic myelopathy who have undergone decompression surgery with fusion. Detailed preoperative and post-operative assessment was done according to modified Japanese Orthopedic Association scoring system.Results: Eighty eight patients of CSM surgical cases were selected for this study and 29 cases of multi-level CSM were observed. And they were randomly selected for anterior and posterior approaches. Sixteen cases anterior approach was done either ACDF or Corpectomy with fusion. Mean age of study was 51.63 years with 64 males and 24 females. The spinal cord level at which most surgeries did was C5/6, 62 cases. While at level C4/5, it was 49 and at level C3/4 and C6/7, it was 35 and 36 respectively.Conclusions: Both anterior approach and posterior approaches were associated with betterment in postoperative neurological function for multilevel CSM. And there is no significant advantage in doing anterior approach in multilevel CSM.

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