Japanese Orthopaedic Association (JOA) Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy,2020 – Secondary publication

Background:Patients with “sandwich” fusion (concomitant C1 occipitalization and C2-C3 nonsegmentation), a subtype of Klippel-Feil syndrome, are at particular risk for developing atlantoaxial dislocation (AAD). However, the clinical and surgical characteristics of AAD in patients with sandwich fusion have not been clearly defined.Methods:A retrospective case-control study with a large sample size and a minimum 2-year follow-up was performed. From 2000 to 2018, 253 patients with sandwich AAD underwent a surgical procedure; these patients constituted the case group, and a matching number of patients with non-sandwich AAD were randomly selected to form the control group. Clinical data from electronic medical records and various imaging studies were analyzed and compared. The Japanese Orthopaedic Association (JOA) scale was used to evaluate neurological function.Results:Patients with sandwich AAD, compared with patients with non-sandwich AAD, had symptom onset at a younger age (34.8 compared with 42.8 years; p < 0.001) and had a higher likelihood for myelopathy (87.4% compared with 74.7%; p < 0.001). Patients with sandwich AAD had a higher incidence of lower cranial nerve palsy (7.9% compared with 0.0%; p < 0.001), a lower preoperative JOA score (13.4 compared with 14.2; p < 0.001), and higher incidences of accompanying Type-I Chiari malformation (20.9% compared with 1.2%; p < 0.001) and syringomyelia (21.3% compared with 1.6%; p < 0.001). Finally, patients with sandwich AAD had higher likelihoods of undergoing transoral release (28.5% compared with 5.1%; p < 0.001) and use of salvage fixation techniques (34.4% compared with 6.3%; p < 0.001), and had lower postoperative results for the JOA score (14.9 compared with 15.9; p < 0.001) and improvement rate (43.8% compared with 58.2%; p < 0.001).Conclusions:Patients with sandwich AAD demonstrated distinct clinical manifestations. Versatility involving the use of various internal fixation techniques and transoral release procedures was frequently required in the surgical management of these patients, and meticulous and personalized preoperative planning would be of paramount importance.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…The Japanese Orthopedic Association (JOA) scale 8 was used to evaluate preoperative neurological impairment and postoperative recovery.…”

Section: Methodsmentioning

confidence: 99%

Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of Sandwich Fusion

Tian

Yue

et al. 2023

Journal of Bone and Joint Surgery

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“…We prospectively recruited all consecutive patients who underwent C3-C7 laminoplasty for CSM at our institution between October 2020 and September 2021. The inclusion and exclusion criteria were determined based on the Japanese Orthopaedic Association Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy, 2020 23. The inclusion criteria were (1) patients with multilevel CSM manifesting in some combination of clinical findings, such as bilateral hand clumsiness and numbness, unsteady gait, weakness in the limbs, muscular dystrophy, hyperreflexia, or positive Hoffmann and Babinski signs; (2) indicated for a C3-C7 laminoplasty because of significant spinal compression indicated by magnetic resonance imaging (MRI), and had persistent neurological symptoms and signs for at least three months, which are not cured by conservative treatment or still progressing despite such treatment; and (3) willingness to participate in the study and sign the informed consent form.…”

Section: Methodsmentioning

confidence: 99%

“…The inclusion and exclusion criteria were determined based on the Japanese Orthopaedic Association Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy, 2020. 23 The inclusion criteria were (1) patients with multilevel CSM manifesting in some combination of clinical findings, such as bilateral hand clumsiness and numbness, unsteady gait, weakness in the limbs, muscular dystrophy, hyperreflexia, or positive Hoffmann and Babinski signs; (2) indicated for a C3-C7 laminoplasty because of significant spinal compression indicated by magnetic resonance imaging (MRI), and had persistent neurological symptoms and signs for at least three months, which are not cured by conservative treatment or still progressing despite such treatment; and (3) willingness to participate in the study and sign the informed consent form. The exclusion criteria were (1) patients with a pattern of anterior spinal cord compression that was not a good indication for C3-C7 laminoplasty alone, ossification of the posterior longitudinal ligament (OPLL), and disk herniation; (2) previous surgery for CSM, active infection, neoplastic disease, rheumatoid arthritis, ankylosing spondylitis, trauma, and concomitant symptomatic lumbar spinal stenosis; and (3) inability to comply with the study because of severe psychosis.…”

Section: Study Populationmentioning

confidence: 99%

Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

Murata

Takami

Endô³

et al. 2022

Spine

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Study Design. A prospective cohort study Objective. To investigate whether the immediate and short-term effects of preoperative electrical peripheral nerve stimulation (ePNS) on performance of the 10-second test could predict the early postoperative outcomes of patients with cervical spondylotic myelopathy (CSM). Summary of Background Data. Previous studies have shown that early clinical improvement in CSM patients may be because of reversal of spinal cord ischemia after spinal cord compression. Materials and Methods. We conducted a 10-second test before surgery, after ePNS, and at discharge (one week after surgery) in 44 patients with CSM who underwent C3-C7 laminoplasty and evaluated their correlations. The effects of the procedures (ePNS or operation) and sides (stimulated or nonstimulated side) for the 10-second test were analyzed using repeated measures analysis of variance. The Pearson correlation coefficient was used to measure the relationship between the 10-second test values according to the method (after ePNS vs. surgery). In addition, the Bland-Altman method was used to evaluate the degree of agreement between the 10-second test obtained after ePNS versus shortly after surgery. Results. The preoperative 10-second test showed the most improvement immediately after the administration of ePNS, with a gradual decrease for the first 30 minutes after completion. After the initial 30 minutes, performance decreased rapidly, and by 60 minutes performance essentially returned to baseline. The 10-second post-ePNS had a strong positive correlation with the 10-second test in the early postoperative period (at discharge=one week after surgery). These phenomena were observed with the left hand, the side stimulated with ePNS, as well as the right hand, the side not stimulated. Conclusions. Early postoperative outcomes after CSM surgery may be predicted by the results of preoperative ePNS. Level of Evidence. Level 3

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“…CSM mainly occurs due to intervertebral disc degeneration, bulging posterior elements, and spinal instability resulting from age-related degenerative changes, while OPLL has a genetic background 1) . The severity of DCM is commonly assessed by the Nurick scale, Japanese Orthopaedic Association (JOA) score, or modified JOA score from the medical providers' perspective 2) . Contrarily, patient-oriented tools for assessing DCM severity vary from the simplest visual analog scale (VAS), the 36-Item Short-Form Health Survey and the EuroQol-5 Dimensions for assessing general health-related quality of life, the Neck Disability Index for patients with neck pain, and the Myelopathy Disability Index and the European Myelopathy Scale to assess highly specific scales for cervical myelopathy 2) .…”

Section: Introductionmentioning

confidence: 99%

“…The severity of DCM is commonly assessed by the Nurick scale, Japanese Orthopaedic Association (JOA) score, or modified JOA score from the medical providers' perspective 2) . Contrarily, patient-oriented tools for assessing DCM severity vary from the simplest visual analog scale (VAS), the 36-Item Short-Form Health Survey and the EuroQol-5 Dimensions for assessing general health-related quality of life, the Neck Disability Index for patients with neck pain, and the Myelopathy Disability Index and the European Myelopathy Scale to assess highly specific scales for cervical myelopathy 2) . The JOA Cervical Myelopathy Assessment Questionnaire (JOACMEQ), originally developed to measure clinical outcomes in patients with cervical myelopathy 3,4) , has also been reported as a reliable tool for surgical outcomes of the cervical spine 5) .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study

Takeda,

Michikawa,

Nagai

et al. 2024

Spine Surg Relat Res

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Introduction:Locomotive syndrome caused by degenerative musculoskeletal diseases is reported to improve with surgical treatment. However, it is unclear whether surgical treatment is effective for the locomotive syndrome developing in patients with degenerative cervical myelopathy (DCM). Thus, this study primarily aimed to longitudinally assess the change in locomotive syndrome stage before and after cervical spinal surgery for patients with DCM using the 25-question geriatric locomotive function scale (GLFS-25). A secondary objective was to identify factors associated with the postoperative improvement in the locomotive syndrome stage. Methods:We retrospectively reviewed clinical data of patients undergoing cervical spine surgery at our institution from April 2020 to May 2022 who had answered the Japanese Orthopaedic Association Cervical Myelopathy Assessment Questionnaire, visual analog scale, and GLFS-25 preoperatively and at 6 months and 1 year postoperatively. We collected demographic data, medical history, preoperative radiographic parameters, presence or absence of posterior longitudinal ligament

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Japanese Orthopaedic Association (JOA) Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy,2020 – Secondary publication

Cited by 9 publications

References 0 publications

Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of Sandwich Fusion

Clinical and Surgical Characteristics of Patients with Atlantoaxial Dislocation in the Setting of Sandwich Fusion

Using Electrical Stimulation of the Ulnar Nerve Trunk to Predict Postoperative Improvement in Hand Clumsiness in Patients With Cervical Spondylotic Myelopathy

Assessment of Surgical Outcomes in Patients with Degenerative Cervical Myelopathy Using the 25-Question Geriatric Locomotive Function Scale: A Longitudinal Observational Study

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