A Clinical Scoring System for Neurological Assessment of High Cervical Myelopathy

Kumar, Raj; Kalra, Samir Kumar; Mahapatra, Ashok Kumar

doi:10.1227/01.neu.0000303195.10544.79

Cited by 17 publications

(11 citation statements)

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“…It has been postulated that sudden release of spinal cord compression causes acute paracentral microhemorrhages in the CMJ and this may be a cause for deterioration of pulmonary function. [1617] Tumiati and workers have proposed that presence of syringomyelia and syringobulbia may also be a cause for altered respiratory drive. [18]…”

Section: Discussionmentioning

confidence: 99%

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

et al. 2014

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Background:Cervicomedullary junction (CMJ) intramedullary tumors comprise of tumors that often pose a surgical challenge even in the present era. Though classified under brainstem glioma CMJ tumors are well amenable for surgical resection and have a good outcome. Various factors are involved in the outcome of these patients following surgery and a proper pre-operative assessment is often required to reduce the morbidity and mortality.Materials and Methods:Patients admitted in the Department of Neurosurgery with a diagnosis of CMJ intramedullary tumors from January 2001 to January 2010 were included in the study. Patients were analyzed retrospectively regarding their symptomatology, clinical findings, radiology and outcome after surgery. All patients underwent pre-operative magnetic resonance imaging (MRI) and post-operatively all were managed in the neurosurgery intensive care unit for days to weeks or as dictated by the clinical condition of the patient.Results:A total of 32 patients were included in the present study. The number of males was 21 (65.6%) and females were 11 (34.4%) respectively. The mean age of presentation was 22.97 ± 9.8 years and the mean duration of pre-operative symptoms was 13.3 ± 12.9 months. The tumor had extension from the CMJ into the cervical region in 17 (53.1%) and into the medullary region in 14 (43.8%) patients. Tumor decompression was done in 9 (28.1%) patients and gross near total excision done in 23 (71.87%) patients.Conclusions:Cervicomedullary tumors are a subset of tumors quite distinct from the usual brainstem tumors. Patients having predominant cervical involvement present early and have less post-operative deficits. Those with predominantly more medullary involvement present late, hence have a much more morbid outcome. Though closely related to vital neural structures, surgery forms the mainstay of treatment. Adequate pre-operative planning and preparation of the patient along with intense post-operative monitoring and ventilatory assistance as and when required helps in a good surgical outcome.

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Section: Discussionmentioning

confidence: 99%

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

et al. 2014

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“…The contoured rod following posterior decompression of the assimilated atlas arch, the rim of the foramen magnum and obstructing posterior dural band and C 2 lamina was fixed between the occiput and C 3 and C 4 levels. The patient is making progressive neurological recovery at a follow-up of 2 months and his disability score [11,12,13] had considerably improved while he is still using the hard cervical collar; the postoperative CVJ radiograph shows reduction in AAD and restoration of alignment of the CVJ.…”

Section: Discussionmentioning

confidence: 99%

Craniovertebral Junction Anomaly with Atlas Assimilation and Reducible Atlantoaxial Dislocation: A Rare Constellation of Bony Abnormalities

et al. 2008

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“…Incentive spirometry and limb physiotherapy was initiated from the OPD itself. At the time of admission, particulars of the patient like name, age, sex, and occupation were noted, and a detailed history including the symptoms and there durations and clinical examination along with K and K[ 4 ] scoring was done and recorded. In patients of fixed AAD or BI, traction was applied 24-48 hours prior to surgery.…”

Section: Methodsmentioning

confidence: 99%

“…Group 1 was patients with ECD between 5-10 mm, Group 2 was patients with ECD between 10-15 mm, and Group 3 was patients with ECD more than 15 mm. The pre-operative and the post-operative clinical status of the patient was assessed by the K and K myelopathic scoring system[ 4 ] [ Table 1 ]. The score was recorded in the pre-operative period, at the time of discharge, at three and six months follow-up.…”

Section: Methodsmentioning

confidence: 99%

Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies

et al. 2016

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Introduction:The effective canal diameter (ECD) for the cranio-vertebral junction is measured from the posterior surface of the dens to the nearest posterior bony structure (foramen magnum or the posterior arch of the atlas). The ECD is the space which is occupied by the buffer space (which can be compromised without producing any signs or symptoms) and the cord itself. We intend to study the role of the ECD (especially in patients with markedly reduced ECD) in producing the symptoms and also the outcome of surgery in patients with bony cranio-vertebral junction (CVJ) anomalies.Materials and Methods:A total of 67 consecutive patients from the period of January 2009 through June 2010 were prospectively included in the study. These patients were operated by a single experienced surgeon (the senior author) at the Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow. The ECD and the pre-operative Kumar and Kalra score (K and K score) (4) was calculated for all patients. The K and K score was also calculated at the time of discharge, at three months and six months follow-up. The patients were divided into three groups based on the ECD into 5 mm to 10 mm group, 10 mm to 15 mm group, and >15 mm group.Results:There were 53 male (79.1%) patients and 14 female patients (20.9%) with mean age of presentation 27.10 years (±15.01 years) with range of 4-59 years. The duration of symptoms in our series varied from 1-120 months with mean of 23.79 months. The mean effective canal diameter was 9.027 mm (±2.23 mm) with range of 5-16 mm. The mean pre-operative K and K score was 19.27 (±4.19). There were 39 patients who had an ECD between 5 mm to 10 mm, 24 patients with ECD between 10 mm to 15 mm, and 4 patients with ECD more than 15 mm. The correlation coefficients between the effective canal diameter and the pre-operative and the post-operative Kumar and Kalra score at the time of discharge, 3 months and 6 months were 0.404 (P < 0.001), 0.320 (P < 0.008), 0.0302 (P < 0.013), and 0.284 (P < 0.020), respectively. The ECD and the pre-operative score were most significantly and strongly related to each other in patients with ECD between 5-10 mm.Conclusion:The ECD is significantly related to the pre-operative status (K and K score) of the patient. This correlation was strongest in the group with ECD of 5-10 mm. It was also observed that as the follow-up increased, the correlation between the ECD and the post-operative K and K score became less stronger though they remained significantly related to each other.

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A Clinical Scoring System for Neurological Assessment of High Cervical Myelopathy

Cited by 17 publications

References 11 publications

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

Clinico-radiological profile and nuances in the management of cervicomedullary junction intramedullary tumors

Craniovertebral Junction Anomaly with Atlas Assimilation and Reducible Atlantoaxial Dislocation: A Rare Constellation of Bony Abnormalities

Role of effective canal diameter in assessing the pre-operative and the post-operative status of patients with bony cranio-vertebral anomalies

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