Neuropsychological Improvement in Patients With Cervical Spondylotic Myelopathy After Posterior Decompression Surgery

Abstract

Patients with cervical spondylotic myelopathy sometimes complain of cognitive dysfunction, which may be coincidence. However, cognitive dysfunction may be related to disorders of the cervical spine and/or spinal cord. This study investigated cognitive dysfunction in patients with cervical spinal disorders. A total of 79 patients with cervical spondylotic myelopathy (40 women and 39 men, mean age 61.2 years) underwent cervical laminoplasty between January 2006 and July 2007. Ten of these 79 patients (7 women and 3 men, mean age 65.2 years) complained of moderate to severe memory disturbances. These 10 patients underwent neuroimaging studies and a battery of neuropsychological tests consisting of the mini-mental state examination, Kohs Block Design Test, Miyake Memory Test, Benton Visual Retention Test (BVRT), and``kana-hiroi'' test before and 3 months after surgery. Brain magnetic resonance imaging showed no organic brain lesions in the 10 patients, but single photon emission computed tomography demonstrated reduced regional cerebral blood flow in the posterior cortical areas in eight patients before surgery. Neuropsychological test scores showed statistically significant improvement after surgery in the Kohs Block Design Test and the BVRT, which measure visuospatial perception and reflect the function of the parietal and/or occipital lobes (p º 0.05). The practice effect may have contributed to the neuropsychological improvements, but this study suggests that cervical spinal disorders may affect cognitive functions and that surgical treatment can ameliorate such effects.

Neural Correlates of Cognitive Dysfunctions in Cervical Spondylotic Myelopathy Patients: A Resting-State fMRI Study

“…However, emerging evidence suggest that cortical alterations may also be crucial in CSM pathology (4)(5)(6)(7). It has been shown that the cortical alterations can only partly restore after decompression surgery (8,9), and the preoperative neural activities can be used as a potential biomarker to predict surgical outcomes (10). To investigate functional alteration at the brain level in CSM patients, functional magnetic resonance imaging (fMRI), which is a highly effective method for investigating neurological and psychological conditions, has been widely applied (11)(12)(13)(14)(15).…”

“…Further, recent studies have intermittently identified symptoms beyond the cord, including depression, anxiety, blurred vision, and cognitive deficits (9,(28)(29)(30)(31). However, the mechanisms underlying CSM pathophysiology at cortical level are poorly studied, and the cognitive aspects are rarely studied in CSM patients.…”

Improvement of severe myalgic encephalomyelitis/chronic fatigue syndrome symptoms following surgical treatment of cervical spinal stenosis

“…They hypothesize that cervical decompression can lead to improvement in symptoms by reducing cord edema, improving venous drainage, and improving cord perfusion [ 40 ]. Hoshimaru has hypothesized that improvements in neuropsychological function among patients with cervical spondylotic myelopathy after decompression surgery could be related to improvement in cerebrospinal flow within the spinal canal, which in turn would be expected to lead to improvement in cerebral blood flow [ 41 ]. These mechanisms would also be potential contributors to changes in ME/CFS and autonomic symptoms.…”

Reversal of lifelong mutism after anterior cervical discectomy and fusion for myelopathy

“…Another study included 79 patients with cervical myelopathy who underwent cervical laminoplasty for decompression of the cervical cord and/or cervical nerves 9. Ten of these patients with memory impairment underwent neuropsychological and neuroimaging testing.…”

“…Several studies have shown a decrease in cognitive performance after cervical spine injury including deficits in problem-solving ability and attention particularly in spinal cord injury 4–7. Interestingly, neuropsychological deficits as a result of spinal cord compression may improve after posterior cervical decompression 8 9. We present a unique case of a 34-year-old previously non-verbal male with severe signs of myelopathy and cervical stenosis that had significant neuropsychological improvement and new ability to speak and verbally communicate after anterior cervical decompression surgery.…”