Management of degenerative cervical myelopathy – An update

Joaquim, Andrei Fernandes; Ghizoni, Enrico; Tedeschi, Hélder; Hsu, Wellington K.; Patel, Alpesh A.

doi:10.1590/1806-9282.62.09.886

Cited by 16 publications

(33 citation statements)

References 45 publications

(62 reference statements)

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“…Sensory abnormalities may be minimal and may not present radicular distribution. Most common are: glove sensation loss in the hands, neck and shoulder pain, paraesthesia in upper extremities, or proprioceptive dysfunctions [2,4,[6][7][8].…”

Section: Clinical Presentationmentioning

confidence: 99%

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Management of patients with cervical myelopathy

Gołębiowska¹

2019

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Myelopathy is a neurological deficit related to the spinal cord, and cervical spondylosis is its leading cause. The majority of middle-aged people have radiological evidence of significant cervical spine degeneration. The most characteristic symptoms are: neck pain with reduced range of motion, pain and paraesthesias in shoulders, gait disturbance, weakness or instability of lower extremities, loss of manual dexterity, and glove-distribution sensory loss in hands. The pathophysiology of cervical spondylotic myelopathy involves static, dynamic, and ischaemic factors. There are two surgical approaches: anterior and posterior. The posterior approach includes laminectomy and laminoplasty. The anterior approach includes anterior discectomy and fusion, and anterior corpectomy and fusion. This paper reviews the pathophysiology and clinical manifestation of cervical spondylotic myelopathy, and surgical approaches to treat patients with this disease. Streszczenie Mielopatia to choroba neurologiczna związana z patologiami rdzenia kręgowego, jej najczęstszą przyczyną jest spondyloza kanału kręgowego w odcinku szyjnym. Radiologiczne cechy znacznej stenozy w tym odcinku ma większość osób w średnim wieku. Najczęściej występującymi objawami są: ból szyi, ograniczony zakres ruchu w odcinku szyjnym kręgosłupa, ból i parestezje ramion, zaburzenia chodu, osłabienie siły i niestabilność kończyn dolnych, zaburzenia wykonywania czynności precyzyjnych dłońmi oraz zaburzenia czucia w okolicy rąk. Czynniki patofizjologiczne wywołujące mielopatię szyjną dzieli się na: statyczne, mechaniczne i niedokrwienne. Wyróżnia się dwa dostępy chirurgiczne-przedni i tylny. Z dostępu tylnego wykonywane są laminektomia i laminoplastyka. Z dostępu przedniego przeprowadza się discektomię ze stabilizacją oraz korpektomię i stabilizację. W artykule przedstawiono patofizjologię, obraz kliniczny oraz metody leczenia operacyjnego spondylozy szyjnej.

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Section: Clinical Presentationmentioning

confidence: 99%

“…The most common motor system is gait dis-turbance [2,3]. Other symptoms that patients complain of are deterioration of fine motor skills, weakness in triceps, atrophy of intrinsic hand muscles, and weakness of proximal muscles of lower extremities [2,3,4,8].…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of patients with cervical myelopathy

Gołębiowska¹

2019

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“…Degenerative cervical spondylosis is the most common cause of myelopathy in elderly patients, and most frequently as a result from stenosis and spinal cord compression below C2. 1 Although cervical stenosis has been extensively studied in the subaxial spine, fewer studies evaluated the role and prevalence of stenosis at the level of the atlas, also known as C1 stenosis. The spinal canal is generally large at the atlantoaxial region, which partially explains the low rate of neurological deficits at presentation in patients with odontoid fractures.…”

Section: Introductionmentioning

confidence: 99%

C1 Stenosis – An Easily Missed Cause for Cervical Myelopathy

et al. 2019

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C1 stenosis is often an easily missed cause for cervical myelopathy. The vast majority of cervical myelopathy occurs in the subaxial cervical spine. The cervical canal is generally largest at C1/2, explaining the relatively rare incidence of neurological deficits in patients with odontoid fractures. However, some subjects have anatomical anomalies of the atlas, which may cause stenosis and result in clinical symptoms similar to subaxial cord compression. Isolated pure atlas hypoplasia leading to stenosis is quite rare and may be associated with other anomalies, such as atlas clefts or transverse ligament calcification. It may also be more commonly associated with syndromic conditions such as Down or Turner syndrome. Although the diagnosis can be easily made with a cervical magnetic resonance imaging, the C3/2 spinolaminar test using a lateral cervical plain radiograph is a useful and sensitive tool for screening. Surgical treatment with a C1 laminectomy is generally necessary and any atlantoaxial or occipito-atlanto instability must be treated with spinal stabilization and fusion.

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“…Intensity changes at the site of compression further predicts clinical outcome after surgery. 6,7,8 Surgery is indicated when clinical sign and symptoms correlate with the radiological findings. The purpose of the surgery is to decompress the cord, maintain the stability of spine and preservation of neurological function.…”

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confidence: 99%

“…Out of 20 patients in posterior group presenting with associated comorbidity (restrictive or obstructive lung disease), 70%(14/20) of patients improved while among 8 patients of anterior group presenting with comorbidity, only 37.5% improved in the immediate post-op period. (Table no 8,10).…”

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confidence: 99%

Outcome in Patients of Cervical Spondylotic Myelopathy, Anterior Versus Posterior Approach- A Retrospective Analysis

Shekhawat¹,

Sharma²,

Vij³

2019

jebmh

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BACKGROUND Cervical spondylotic myelopathy is a complex multi-factorial disease process having both metabolic and biomechanical factors. The choice of the surgical approach, whether anterior or posterior, is determined by many factors. The objective of this study is to compare the surgical outcome and post-operative complications among both the surgical groups in patients with cervical CSM at a tertiary care centre. MATERIALS AND METHODS The study was conducted at tertiary care centre in Jaipur. Retrospective data of 70 patients was collected who were operated for cervical spondylotic myelopathy from Dec 2016-Jan 2018. The patients were divided into 2 groups (35 in each group) based on the approach used for surgery-anterior or posterior. The patients' demographics, MRI findings and pre-op neurological status were considered. Clinical outcome and incidence of complications were compared among both the groups. Follow-up was done at immediate post-op, 3 months and 6 months. RESULTS The mean age of the patients in anterior and posterior group was 50.54 and 57.5 years respectively. There were 22 and 48 females and males respectively. In anterior group, 13 patients had lesion on >1 level while in posterior group, all the patients had multi-segmental level involvement. Immediate clinical outcome was considered-whether patient improved, remained same as in pre-op state or deteriorated. In both anterior and posterior groups, 77.14% of patients improved. The incidence of immediate post-op complications was higher in anterior group. CONCLUSION No difference in outcome was seen among patients of both the groups. Incidence of post-op complications was higher in the anterior group. The choice of surgical approach is also affected by age and associated comorbidity. Posterior approach is preferable with increasing age, and associated comorbidity. With rising trends in anterior approach, posterior approach (decompressive laminectomy) is still the best armamentarium in selected patients.

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Management of degenerative cervical myelopathy – An update

Abstract: Joaquim aF et al. 886rev assoc Med Bras 2016; 62(9):886-894

Cited by 16 publications

References 45 publications

Management of patients with cervical myelopathy

Management of patients with cervical myelopathy

C1 Stenosis – An Easily Missed Cause for Cervical Myelopathy

Outcome in Patients of Cervical Spondylotic Myelopathy, Anterior Versus Posterior Approach- A Retrospective Analysis

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