Importance of Sagittal Alignment of the Cervical Spine in the Management of Degenerative Cervical Myelopathy

Buell, Thomas J.; Buchholz, Avery L.; Quinn, John C.; Shaffrey, Christopher I.; Smith, Justin S.

doi:10.1016/j.nec.2017.09.004

Cited by 37 publications

(46 citation statements)

References 64 publications

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“…The effect of the cervical spine curvature to outcomes has also been examined by others. Buell et al [64] have analyzed neurological improvement in patients both with and without normal cervical curvature. They found that neurological improvement was significant only in patients with normal cervical lordosis.…”

Section: Radiological Variables Affecting Prognosismentioning

confidence: 99%

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Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Zılelı¹,

Maheshwari²,

Kale³

et al. 2019

Neurospine

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This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.

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Section: Radiological Variables Affecting Prognosismentioning

confidence: 99%

“…Decompression with stabilization of the cervical spine in lordosis of the operated segment allows the posterior shift of the spinal cord [64].…”

Section: Radiological Variables Affecting Prognosismentioning

confidence: 99%

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Zılelı¹,

Maheshwari²,

Kale³

et al. 2019

Neurospine

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“…DCM encompasses a number of related conditions such as cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), ossification of the ligamentum flavum, degenerative disc disease, and various congenital malformations that cause stenosis or instability leading to eventual spinal cord dysfunction [2]. It is now the commonest form of spinal cord dysfunction in adults [3], and has become an increasingly important area of focus for spine surgeons and clinician scientists in recent years [4,5,6,7,8,9]. This renewed focus has primarily been driven by a greater understanding of the benefit of timely intervention [5,7,10,11], and international clinical practice guidelines for the management of DCM were published in 2017 [7].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies

Wilson

Badhiwala

Jiang

et al. 2019

JCM

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Background: The effect on functional and quality of life (QOL) outcomes of surgery in elderly degenerative cervical myelopathy (DCM) patients has not been definitively established. Objective: To evaluate the effect of older age on the functional and QOL outcomes after surgery in an international, multi-center cohort of patients with DCM. Methods: 107 patients aged over 70 years old (mean 75.6 ± 4.4 years) were enrolled in the AOSpine CSM-North America and International studies. A propensity-matched cohort of 107 patients was generated from the remaining 650 adults aged <70 years old (mean 56.3 ± 9.6 years), matched to gender, complexity of surgery, co-morbidities, and baseline functional impairment (modified Japanese Orthopedic Association scale (mJOA). Functional, disability, and QOL outcomes were compared at baseline and at two years post-operatively, along with peri-operative adverse events. Results: Both cohorts were equivalently matched. At two years, both cohorts showed significant functional improvement from the baseline but the magnitude was greater in the younger cohort (mJOA 3.8 (3.2–4.4) vs. 2.6 (2.0–3.3); p = 0.007). This difference between groups was also observed in the SF-36 physical component summary (PCS) and mental component summary (MCS) outcomes (p = <0.001, p = 0.007), but not present in the neck disability index (NDI) scores (p = 0.094). Adverse events were non-significantly higher in the elderly cohort (22.4% vs. 15%; p = 0.161). Conclusions: Elderly patients showed an improvement in functional and QOL outcomes after surgery for DCM, but the magnitude of improvement was less when compared to the matched younger adult cohort. An age over 70 was not associated with an increased risk of adverse events.

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“…The unusual morphology may induce uncomfortable conditions including pain and fatigue. As for cervical spine, we enrolled CL combined with T1 slope and CSVA as main predictors to analyses possible correlations with neck pain [27]. Similarly, lumbar-pelvic alignments were utilized to detect possible correlations with back pain.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Risk Factors for Spinal Pain: A Case Control Study of New Graduate Aviators Based on Imaging and Questionnaire Results.

Xie

et al. 2020

Preprint

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Background: Disc degenerative diseases are common in occupational aviators exposed to long flight time and vibration during flight. The incidence of pathological and degenerative changes of spine in experienced pilots are widely studied and reported. However, few literatures focused on new graduate aviators. In this study we intended to describe imaging features of spine in new graduate aviators from flight academy and analyzed the risk factors for spinal pain.Methods: This is a retrospective study of 178 new graduate aviators. All received full-length lateral X-ray of spine and 1.5T magnetic resonance imaging (MRI) of cervical and lumbar spine. Sagittal alignments were measured through X-ray imaging. The degenerative grade of disc was defined according to Miyazaki and Pfirrmann grading classifications. The prevalence of degenerative disc diseases was reported under disc nomenclatures. The incidence of spinal pain during the last 12 months of flight training was acquired from questionnaires. Multivariate logistic regression analysis was utilized to analyses risk factors for spinal pain.Results: The whole cohort presented at least one level disc degeneration of Grade 2 in cervical or lumbar spine. 134 of 178 subjects (75.3%) showed at least one cervical disc degeneration in grade 3. 61 (34.3%) presented cervical disc bulging and 5 (3%) presented cervical disc protrusion. 110 (61.8%) aviators reported neck pain during the last 12 months. 53 of 178 (29.8%) volunteers had at least one lumbar disc degeneration in grade 3. 31 (17.4%) aviators presented lumbar disc bulging and 21 (11.8%) presented lumbar disc protrusion. 45 (25.3%) aviators reported back pain during the last 12 months. Multivariate logistic regression analysis showed age, cervical disc degeneration and bulging were risk factors for neck pain; lumbar disc degeneration, bulging and protrusion were risk factors for back pain. Conclusions: Moderate degrees of disc degenerative changes and diseases of spine could be found in new graduate aviators at an early age. Disc degeneration and diseases correlate strongly with spinal pain. It is essential to recognize these pathological conditions to intervene in the occurrence and development of degenerative changes in aviators in advance.

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Importance of Sagittal Alignment of the Cervical Spine in the Management of Degenerative Cervical Myelopathy

Cited by 37 publications

References 64 publications

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies

Analysis of Risk Factors for Spinal Pain: A Case Control Study of New Graduate Aviators Based on Imaging and Questionnaire Results.

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