Multivariate analysis of the neurological outcome of surgery for cervical compressive myelopathy

Uchida, Kenzo; Nakajima, Hideaki; Sato, Ryuichiro; Kokubo, Yasuo; Yayama, Takafumi; Kobayashi, Shigeru; Baba, H.

doi:10.1007/s00776-005-0953-1

Cited by 89 publications

(66 citation statements)

References 18 publications

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“…Cervical spondylosis often manifests with spastic tetraparesis with varying degrees of sensory dysfunction [6,10,11,14,26,45]. Crandall et al [10] indicated that somewhat less than 7% of patients with cervical spondylotic myelopathy present with minimal sensation loss, and classified this subtype of the disorder as cervical spondylotic amyotrophy.…”

Section: Introductionmentioning

confidence: 99%

Cervical spondylotic amyotrophy

Jiang

Dai

2010

Eur Spine J

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Cervical spondylotic amyotrophy is characterized with weakness and wasting of upper limb muscles without sensory or lower limb involvement. Two different mechanisms have been proposed in the pathophysiology of cervical spondylotic amyotrophy. One is selective damage to the ventral root or the anterior horn, and the other is vascular insufficiency to the anterior horn cell. Cervical spondylotic amyotrophy is classified according to the most predominantly affected muscle groups as either proximaltype (scapular, deltoid, and biceps) or distal-type (triceps, forearm, and hand). Although cervical spondylotic amyotrophy always follows a self-limited course, it remains a great challenge for spine surgeons. Treatment of cervical spondylotic amyotrophy includes conservative and operative management. The methods of operative management for cervical spondylotic amyotrophy are still controversial. Anterior decompression and fusion or laminoplasty with or without foraminotomy is undertaken. Surgical outcomes of distal-type patients are inferior to those of proximal-type patients.

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Section: Introductionmentioning

confidence: 99%

Cervical spondylotic amyotrophy

Jiang

Dai

2010

Eur Spine J

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“…Decreased cross sectional area of the spinal cord has also been shown to correlate with neurologic deficits and pathologic cord changes in other neurologic or spinal disorders, such as multiple sclerosis (MS) [34][35][36][37][38][39][40][41][42][43]. It may be hypothesized that the decreased spinal canal and/or spinal cord measurements present in the 22q11.2 population could potentially be predictive of future neurologic risk, particularly as these children grow into adults.…”

Section: Discussionmentioning

confidence: 99%

Advanced imaging of the cervical spine and spinal cord in 22q11.2 deletion syndrome: Age-matched, double-cohort, controlled study

Ricchetti

Hosalkar

Gholve

et al. 2008

Journal of Children's Orthopaedics

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Purpose The 22q11.2 deletion syndrome is a common genetic syndrome with a wide spectrum of abnormalities. We have previously described multiple anomalies of the upper cervical spine in this disorder. The objective of this study was to use advanced imaging to further define the morphology of the cervical spine and spinal cord in the 22q11.2 deletion syndrome, with a comparison to agematched controls. Methods A total of 32 patients with a 22q11.2 deletion underwent advanced imaging (computed tomography/ magnetic resonance imaging; CT/MRI) of the cervical spine. In 27 patients, space available for the cord (SAC); the sagittal diameter of the vertebral body, spinal canal, cerebrospinal fluid (CSF), and spinal cord; and the cross sectional area of the spinal canal, CSF, and spinal cord were measured at each cervical level and compared to 29 age-matched controls. Statistical analysis was performed and potential implications were hypothesized. Results In 22q11.2 patients, advanced imaging identified 40 pathologies not evident on plain radiographs with potential mechanical and/or neurological implications. These patients also had significantly smaller values (P B 0.05) of the following parameters at one or more cervical levels, relative to age-matched controls: width of the vertebral body, spinal canal, CSF, and spinal cord; area of the spinal canal, CSF, and spinal cord. Neurologic symptoms were observed in 4/32 patients, with one patient requiring surgical intervention. Conclusions Advanced imaging of the cervical spine can detect findings not evident on plain radiographs in the 22q11.2 deletion syndrome. CT and/or MRI may be indicated when there is a high index of suspicion for clinical instability or neurologic compromise in order to rule out dynamic encroachment or impending neurologic sequelae. Spinal canal and spinal cord dimensions are reduced in these patients relative to controls with currently unknown clinical significance.

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“…[22][23][24] Also in severe compressive myelopathy, spinal cord dimension was correlated with the outcome. [25][26][27] In KFS, however, Samartzis et al advocated that increased space available for the cord would protect from neurologic complication instead of aggravating it. 28 Therefore, it is reasonable to deduce that the spinal cord enlarges as patients with KFS grow.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Global Spine J

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Study Design Retrospective case-control study. Objectives To confirm the fact that spinal cord dimensions are smaller in adults with Klippel-Feil syndrome (KFS) than in pediatric patients with KFS and to compare the clinical characteristics and outcomes of neurologic complications in patients with KFS with matched controls. Methods We performed an independent 1:2 case-control retrospective radiographic and chart review of a consecutive series of adults with KFS who underwent surgical intervention. The control group consisted of consecutive non-KFS surgical patients. Patients were matched in 1:2 case-control manner. Their charts were reviewed and the clinical characteristics were compared. Axial T2-weighted magnetic resonance imaging (MRI) was used to measure the anteroposterior and mediolateral axial spinal cord and spinal canal at the operative levels and measurements were compared. Results A total of 22 patients with KFS and 44 controls were identified. The KFS group had a tendency of more myeloradiculopathy, and the control group had a tendency toward more radiculopathy. Both tendencies, however, were not significantly different. MRIs of 10 patients from the KFS group and 22 controls were available. There was no difference in the area of both spinal cord and canal at the operative levels. Conclusion Contrary to the finding in previous reports on pediatric patients, there were no differences between KFS and well-matched control groups in terms of age of onset, presentation, revision rate, complication rate, surgical outcome, and crosssectional spinal cord and canal dimensions at the operative level.

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Multivariate analysis of the neurological outcome of surgery for cervical compressive myelopathy

Abstract: We suggest that multivariate analysis is useful for assessing the neurosurgical outcome in patients with cervical compressive myelopathy.

Cited by 89 publications

References 18 publications

Cervical spondylotic amyotrophy

Cervical spondylotic amyotrophy

Advanced imaging of the cervical spine and spinal cord in 22q11.2 deletion syndrome: Age-matched, double-cohort, controlled study

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