Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy

Tetreault, Lindsay; Tan, Gamaliel; Kopjar, Branko; Côté, Pierre; Arnold, Paul M.; Nugaeva, Natalia; Barbagallo, Giuseppe; Fehlings, Michael G.

doi:10.1227/neu.0000000000001151

Cited by 43 publications

(48 citation statements)

References 35 publications

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“…Our findings may contribute to explaining why patients with a longer preoperative duration of symptoms achieve suboptimal surgical outcomes with respect to neurological recovery, functional impairment, and quality of life (7,42,43). We demonstrated that patients with a duration of symptoms greater than or equal to 6 months exhibited smaller functional improvements in functional recovery at 2 years following decompressive surgery than those with a duration of symptoms less than 6 months.…”

Section: Discussionmentioning

confidence: 56%

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

Vidal¹,

Karadimas²,

Ulndreaj³

et al. 2017

JCI Insight

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Degenerative cervical myelopathy (DCM) is the most common progressive nontraumatic spinal cord injury. The most common recommended treatment is surgical decompression, although the optimal timing of intervention is an area of ongoing debate. The primary objective of this study was to assess whether a delay in decompression could influence the extent of ischemia-reperfusion injury and alter the trajectory of outcome in DCM. Using a DCM mouse model, we show that decompression acutely led to a 1.5- to 2-fold increase in levels of inflammatory cytokines within the spinal cord. Delayed decompression was associated with exacerbated reperfusion injury, astrogliosis, and poorer neurological recovery. Additionally, delayed decompression was associated with prolonged elevation of inflammatory cytokines and an exacerbated peripheral monocytic inflammatory response (P < 0.01 and 0.001). In contrast, early decompression led to resolution of reperfusion-mediated inflammation, neurological improvement, and reduced hyperalgesia. Similar findings were observed in subjects from the CSM AOSpine North America and International studies, where delayed decompressive surgery resulted in poorer neurological improvement compared with patients with an earlier intervention. Our data demonstrate that delayed surgical decompression for DCM exacerbates reperfusion injury and is associated with ongoing enhanced levels of cytokine expression, microglia activation, and astrogliosis, and paralleled with poorer neurological recovery.

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Section: Discussionmentioning

confidence: 56%

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

Vidal¹,

Karadimas²,

Ulndreaj³

et al. 2017

JCI Insight

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“…This was done using prospectively collected data on 743 patients enrolled in either the CSM-International or the CSM-North America multicenter study. We incorporated results from our original North American prediction study and external validation study to create a clinically relevant and globally valid model that could be implemented into surgical practice 6,7 . Based on our findings, patients were more likely to achieve a score of ‡16 on the mJOA if they were younger, had milder myelopathy and a shorter duration of symptoms preoperatively, did not smoke, had fewer and less severe comorbidities, and did not present with impaired gait.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Prediction Rule for Functional Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy

Tetreault

Kopjar

Côté

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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113

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“…Eine Überlegenheit eines Verfahrens hinsichtlich der Besserung der Symptome der Myelopathie ließ sich nicht herausarbeiten [21]. Auch die prozentuale Komplikationsrate ist vergleichbar, wenngleich sich die Qualität der Komplikationen unterscheidet: Bei den anterioren Operationen finden sich neben der bereits erwähnten ASD vergleichsweise häufiger Heiserkeit, Dysphagie und Pseudarthrose/Implantatversagen, bei posterioren Eingriffen Wundinfektionen, Nackenschmerzen sowie eine C5-Parese [22,23].…”

Section: Operative Therapie Bei Zervikaler Spondylose: Posteriore Verunclassified

Der zervikale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

Rohde

2019

Die Wirbelsäule

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ZusammenfassungDie alters- und belastungsabhängige Degeneration der Halsbandscheibe kann zu einem weichen Halsbandscheibenvorfall führen oder eine Kaskade weiterer Prozesse auslösen, welche in einen harten Bandscheibenvorfall, die zervikale Spondylose, einmünden. Während ein Wurzelreiz- oder Wurzelkompressionssyndrom die vorherrschende Symptomatik beim weichen Bandscheibenvorfall ist, dominiert bei der zervikalen Spondylose die Myelopathie. Bildgebende Verfahren zur Diagnosestellung sind die Magnetresonanztomographie (MRT) und Computertomographie (CT), bei geplanter Operation gegebenenfalls ergänzt durch Röntgenaufnahmen in Neutral-, Flexions- und Extensionsstellung. Bei einem weichen Bandscheibenvorfall besteht eine Operationsindikation bei einem therapieresistenten radikulären Schmerzsyndrom oder einer myotombezogenen Parese. Bei einer zervikalen Spondylose ist spätestens bei Nachweis einer moderaten Myelopathie eine Operation unumgänglich. Es existieren sowohl für den weichen Bandscheibenvorfall als auch für die zervikale Spondylose etablierte anteriore und posteriore Operationsverfahren. Auch wenn es in Deutschland eine deutliche Präferenz für anteriore Verfahren gibt, konnte bislang keine Überlegenheit eines Verfahrens sowohl hinsichtlich Symptomkontrolle als auch hinsichtlich Komplikationsquote gezeigt werden.

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Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy

Abstract: BMI, body mass indexCSM, cervical spondylotic myelopathymJOA, modified Japanese Orthopaedic AssociationOPLL, ossification of the posterior longitudinal ligament.

Cited by 43 publications

References 35 publications

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

A Clinical Prediction Rule for Functional Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy

Der zervikale Bandscheibenvorfall – Spontanverlauf, Therapieoptionen und klinische Ergebnisse

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