Biomechanical Considerations in the Surgical Management of Cervical Spondylotic Myelopathy

White, Augustus A.; Panjabi, M M

doi:10.1097/00007632-198807000-00029

Cited by 173 publications

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“…In elderly Japanese CSM patients, the rate of occurrence of dynamic factors, such as instability of the vertebral column [1,[6][7][8]29], was shown to be higher than for static factors, such as developmental canal stenosis [24], by radiological analysis [26]. Furthermore, CSM patients 65 years and older with spondylolisthesis had a high incidence of degenerative spondylolisthesis (DS) at C3-C4 or C4-C5 [14].…”

Section: Introductionmentioning

confidence: 99%

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients

Shigematsu

2010

Eur Spine J

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The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients ([65 years old) who eventually had surgical treatment for CSM were evaluated. A slippage displacement of more than 2.5 mm at least at one level was classified to have a positive DS on flexion/extension radiographs (DS group). A slippage displacement less than 1.0 mm was considered a negative DS (non-DS group). Seventeen patients who had slippage of 1.0-2.5 mm were excluded from the study. The DS group (n = 15) included cases with DS at preoperation, while the remaining cases (n = 17) belonged to the non-DS group. The flexion/ extension radiographs of the two groups were compared for range of motion and clinical results at 3 years after the operation. Of all elderly patients, 30.6% had DS. There was no significant difference between the two groups based on the clinical results. The range of motion of all cervical spines (DS group and non-DS group) was significantly limited. However, there was no significant difference between the two groups. New postoperative DS appeared in four patients, of which two were from the DS group and two from the non-DS group. These data suggest that degenerative spondylolisthesis does not influence surgical results in elderly cervical spondylotic myelopathy patients.

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Section: Introductionmentioning

confidence: 99%

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients

Shigematsu

2010

Eur Spine J

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“…Patients with a congenitally narrow canal (<13 mm) are at a higher risk for developing clinical features from staticmechanical compression [11]. A narrowed spinal canal is thought to cause compression of the spinal cord, leading to local tissue ischaemia, neural cell injury and neurological impairment.…”

Section: Pathophysiologymentioning

confidence: 99%

“…One study showed that cervical myelopathy is strongly suspected when the dynamic canal space during extremes of flexion or extension is (<11 mm) [11]. In conjunction with a pre-existing cervical canal stenosis, there is increased strain and shear pathological forces applied on the spinal cord, which can potentially cause localised and widespread axonal injury [12].…”

Section: Pathophysiologymentioning

confidence: 99%

Cervical Myelopathy: Pathophysiology, Diagnosis, and Management

Virdi¹

2017

Spine Res

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The natural history of cervical myelopathy involves both static and dynamic factors which trigger a cascade of reactions resulting in cord compression and ischemic dysfunction of the spinal cord. Conservative management is an option in those with mild Cervical Spondylotic Myelopathy (CSM), though close clinical and radiological follow-up is important. Operative management remains the standard of treatment for more symptomatic CSM, however, indications must be carefully considered with each individual patient. A randomized, double-blind, placebo-controlled multi-centre study, assessing whether Riluzole (a neuroprotective drugs) has any benefits as a treated for surgical decompression in those with CSM, is being carried out. Here we review the pathophysiological, diagnostic and treatment aspects of CSM.

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“…In flexion, the spinal cord lengthens, which results in axial tension and, potentially, ischemia. [13][14][15] In extension, the spinal canal shortens so that its cross-sectional area decreases. Furthermore, the ligamentum flavum buckles inward.…”

mentioning

confidence: 99%

“…Both changes result in a high risk of compression of the cervical spinal cord. 2,11,15,16 The third component consists of histopathologic and vascular changes resulting in ischemia, infarction, apoptosis, and other toxic cell alterations. [17][18][19][20] The natural history of CSM seems dependent on the severity of the condition.…”

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confidence: 99%

Treatment considerations of cervical spondylotic myelopathy

Shiban

Meyer

2014

Neur Clin Pract

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SummaryCervical spondylotic myelopathy (CSM) is the leading cause of myelopathy in patients over age 50 years. Despite advances, CSM remains a clinical diagnosis and its natural history remains unclear. The treatment of CSM is controversial, especially in patients with mild or moderate clinical disease without rapid progression of symptoms. Herein, we begin with a clinical vignette followed by a brief description of the clinical problems. We discuss evaluation, treatment, and recommendations for the treatment of CSM. Emphasis is drawn to areas of uncertainty and present level of evidence for the treatment modalities of CSM.C ervical spondylotic myelopathy (CSM) is a degenerative condition of the cervical spine and the leading cause of myelopathy in those over the age of 50. 1-3 The exact incidence and prevalence of CSM is unknown. 1 Initially, patients may present with any of the following symptoms: neck pain and decreased mobility of the cervical spine, numb or clumsy hands, unsteady gait, hyperreflexia, and spasticity. In time, upper extremity weakness, muscle atrophy, or sphincter dysfunction might develop. [4][5][6][7] Clinical vignette A 61-year-old teacher with a history of intermittent neck pain is seen after 5 months of continuing neck pain. MRI 2 months after the onset of pain showed degenerative changes with spinal stenosis in the cervical region. He is very anxious because the first physician he consulted recommended decompressive surgery and the second recommended conservative treatment and to avoid surgery. He read on the Internet that he could eventually become paralyzed and therefore seeks further opinions. How should this patient be evaluated and treated?The pathophysiology of CSM involves 3 main components. The first component is the static factor, where structural changes cause spinal canal stenosis and cord compression. A strong correlation has been demonstrated between narrowing of the sagittal diameter of the cervical

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Biomechanical Considerations in the Surgical Management of Cervical Spondylotic Myelopathy

Cited by 173 publications

References 0 publications

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients

Cervical Myelopathy: Pathophysiology, Diagnosis, and Management

Treatment considerations of cervical spondylotic myelopathy

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