Maximum voluntary ventilation as a sensitive measure to monitor the ventilatory function in cervical spondylotic myelopathy

Abstract

Study design: A prospective clinical cohort study. Objectives: To test if maximum voluntary ventilation (MVV), which is currently underutilized in diseases, serves for assessing subclinical ventilatory impairment in cervical spondylotic myelopathy (CSM). Setting: Kochi Medical School, Japan. Methods: We studied ventilatory function in 49 CSM patients and 20 age-and sex-matched control patients with either lumbar stenosis or lower limb osteoarthritis. All patients underwent ventilatory function studies consisting of flow volume curves, vital capacity (VC) and the MVV in 12 s before and after surgery. Tetraparesis was assessed by the functional scale of the Japanese Orthopaedic Association (JOA). Results: The CSM group had significantly smaller %forced VC , %peak expiratory flow rate (%PEFR) and %MVV than the control group preoperatively. In contrast to the control group, the CSM group showed a significant increase in %MVV from 74.9±18.7% preoperatively to 80.3 ± 19.0% postoperatively (Po0.005), but not in any other ventilatory measures. This postoperative increase in %MVV significantly correlated with the JOA score (r¼0.493; Po0.001). As a possible effect of diaphragmatic recovery, the %PEFR significantly increased postoperatively only in patients with the primary site of involvement at or rostral to C3-4. Conclusion: Of the various ventilatory measurements, MVV was most sensitive to changes in tetraparesis in CSM, presumably because MVV, unlike the other ventilatory measures, reflects the coordination in addition to the strength of respiratory muscles.

Life expectancy after cervical laminoplasty-Causes of the fatal prognosis at the early stage (within 5 years) -

“…In our study, there was no data regarding the pre- and post-operative patients' respiratory function. Previous study showed that MVV% was significantly correlated with postoperative recovery of the JOA score 7 ) . Unsatisfactory post-operative recovery, including impaired recovery of respiratory function, might be related to the early death in the S group.…”

“…Previous studies demonstrated that cervical myelopathy impaired respiratory function 6-8 ) . Nomura et al reported that forced vital capacity%, peak flow rate, and maximum voluntary ventilation (MVV)% in patients with cervical myelopathy was smaller than those in normal controls 6 , 7 ) . Toyoda et al found that expiratory flow was impaired in patients with cervical myelopathy 8 ) .…”

Restrictive ventilatory impairment improved by laminoplasty for ossification of the posterior longitudinal ligament

“…Meanwhile, respiratory dysfunction in chronically progressive cervical myelopathy is often subtle and subclinical, and respiratory problems rarely become the main symptoms. There are several reports showing that pulmonary function (especially VC) decreases due to cervical myelopathy including OPLL, and some show improvement in pulmonary function after cervical spine surgery (Table ). However, the preoperative %VCs of patients with chronic cervical myelopathy in these reports were as mild as 65.0%‐97.9%, whereas the %VC of our patient was reduced to 39.4%.…”

Heartbroken Child: A Rare Case Report of Neurogenic Pulmonary Edema and Takotsubo Cardiomyopathy following Recurrent Medulloblastoma Excision with Possible Aetio-Patho-Bio-Physiological Mechanisms

“…In age less than 18 years, it is mainly seen in adolescents suffering from psychiatric disorders and substance abuse [6,7]. In children, it is rarely described [6][7][8], even though extradural cerebellar haematoma [9], parenchymal cerebellar haematoma [9], and acute hydrocephalus [10,11] secondary to any cause have been described in single case reports. We present here a very unique case of a 12-year-old child with neurogenic pulmonary oedema (NPE) and takotsubo cardiomyopathy (TCM) syndrome after surgery for recurrent medulloblastoma.…”