Outcomes of Surgical Decompression in Patients With Very Severe Degenerative Cervical Myelopathy

Kopjar, Branko; Bohm, Parker; Arnold, Joshua H.; Fehlings, Michael G.; Tetreault, Lindsay; Arnold, Paul M.

doi:10.1097/brs.0000000000002602

Cited by 25 publications

(15 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our series, we had an improvement in the mJOA score from 13.9 to 16.5. This is in accordance to other main series [15,16,23].…”

Section: Discussionsupporting

confidence: 93%

“…Our results confirm recent series [6,7,10,11,12,13,14,15,16] in which the anterior approach for the treatment of more than four levels (cervical) is safe and effective in the treatment of multilevel cervical degenerative myelopathy and radiculopathy, in addition to multilevel cervical spondylodiscitis, complex traumatic cervical fractures, metastatic cervical spine tumor, and ossification of the posterior longitudinal ligament.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Oni

Schultheiß

Scheufler

et al. 2018

JCM

View full text Add to dashboard Cite

Background: Multilevel anterior cervical decompression and fixation of four and more levels is a common surgical procedure used for several diseases. Methods: We reviewed the radiological and clinical outcomes after anterior cervical discectomy or corpectomy and fixation of four and more levels in 85 patients (55 men and 30 women) with an average age of 59.6 years. Surgical indication was multilevel cervical degenerative myelopathy and radiculopathy in 72 (85%) patients, multilevel cervical spondylodiscitis in four (5%), complex traumatic cervical fractures in four (5%), metastatic cervical spine tumor in two (2%), and ossification of the posterior longitudinal ligament in three (3%) patients. Results: There were no severe intraoperative complications such as spinal cord or vertebral artery injury or dissection. Seventy-three patients had four, 10 patients had five, and two patients had six anterior cervical level fixations. The visual analog scale (VAS) and Japanese Orthopedic Association (mJOA) scale scores improved (6.9 to 1.3 (p < 0.001) and 13.9 to 16.5 (p < 0.001), respectively). The Cobb angle increased from 5.7° to 17.6° postoperatively (p < 0.001). Secondary posterior fixation was necessary in three cases due to pseudarthrosis. Conclusion: The anterior approach appears to be optimal for ventral compressive pathology and lordosis restoration to the cervical spine. Limitations of multiple level decompression and fixation included increasing pseudoarthrosis rates, especially after corpectomy, and increasing fused level numbers.

show abstract

“…In our series, we had an improvement in the mJOA score from 13.9 to 16.5. This is in accordance to other main series [15,16,23].…”

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 89%

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Oni

Schultheiß

Scheufler

et al. 2018

JCM

View full text Add to dashboard Cite

show abstract

“…After surgery, the functional outcome indicated by the mJOA-LEF and Nurick scale improved; however, the functional outcome indicated by the JOACMEQ-LEF score did not. The mJOA results were consistent with the results of previous studies, in which the mJOA and Nurick scale have been demonstrated to improve 3 and 6 months after surgery in patients with CSM [42, 43]. Moreover, a previous study that used the functional independence measure for assessing locomotion in patients with CSM reported a positive surgical effect on locomotion [44].…”

Section: Discussionsupporting

confidence: 89%

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

Lin

Lai

Ding

et al. 2019

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

Background Cervical spondylotic myelopathy (CSM) is a degenerative cervical disease in which the spinal cord is compressed. Patients with CSM experience balance disturbance because of impaired proprioception. The weighting of the sensory inputs for postural control in patients with CSM is unclear. Therefore, this study investigated the weighting of sensory systems in patients with CSM. Method Twenty-four individuals with CSM (CSM group) and 24 age-matched healthy adults (healthy control group) were analyzed in this observational study. The functional outcomes (modified Japanese Orthopaedic Association Scale [mJOA], Japanese Orthopaedic Association Cervical Myelopathy Questionnaire [JOACMEQ], Nurick scale) and static balance (eyes-open and eyes-closed conditions) were assessed for individuals with CSM before surgery, 3 and 6 months after surgery. Time-domain and time–frequency-domain variables of the center of pressure (COP) were analyzed to examine the weighting of the sensory systems. Results In the CSM group, lower extremity function of mJOA and Nurick scale significantly improved 3 and 6 months after surgery. Before surgery, the COP mean velocity and total energy were significantly higher in the CSM group than in the control group for both vision conditions. Compared with the control group, the CSM group exhibited lower energy content in the moderate-frequency band (i.e., proprioception) and higher energy content in the low-frequency band (i.e., cerebellar, vestibular, and visual systems) under the eyes-open condition. The COP mean velocity of the CSM group significantly decreased 3 months after surgery. The energy content in the low-frequency band (i.e., visual and vestibular systems) of the CSM group was closed to that of the control group 6 months after surgery under the eyes-open condition. Conclusion Before surgery, the patients with CSM may have had compensatory sensory weighting for postural control, with decreased weighting on proprioception and increased weighting on the other three sensory inputs. After surgery, the postural control of the patients with CSM improved, with decreased compensation for the proprioceptive system from the visual and vestibular inputs. However, the improvement remained insufficient because the patients with CSM still had lower weighting on proprioception than the healthy adults did. Therefore, patients with CSM may require balance training and posture education after surgery. Trial registration Trial Registration number: NCT03396055 Name of the registry: ClinicalTrials.gov Date of registration: January 10, 2018 - Retrospectively registered Date of enrolment of the first participant to the trial: October 19, 2015

show abstract

“…Our literature search of cases of cervical spondylosis presenting with severe or very severe symptoms related to myelopathy revealed that although effective and the extent of improvement is substantial, the results of decompressive surgical treatment were only marginally successful, and the patients continued to have “significant” residual neurological deficits. [222324] Although exact comparison with other clinical reports on the subject is difficult or impossible to make, it appears that the results of our surgical treatment that involved only spinal stabilization were significantly superior to that obtained by surgical treatment that involved decompression of bone and soft tissue elements. In the various reported case series, the bulk of clinical improvement treated by decompressive surgery has been identified 6 months postoperatively; all our patients showed significant clinical symptomatic improvement in the “immediate” postoperative period.…”

Section: Discussionmentioning

confidence: 70%

Cervical spondylosis in patients presenting with “severe” myelopathy: Analysis of treatment by multisegmental spinal fixation – A case series

Goel

Vutha

Shah

et al. 2019

J Craniovert Jun Spine

View full text Add to dashboard Cite

Background:Surgical strategy of multisegmental spinal fixation that includes atlantoaxial joint for patients having cervical spondylosis-related symptoms of severe myelopathy is analyzed.Objective:Surgical outcome of patients presenting with “severe” symptoms of cervical myelopathy having multisegmental degenerative cervical spondylosis and treated by multisegmental spinal fixation is analyzed. Atlantoaxial joint was included in the fixation construct in majority of patients. No bone, soft tissue, osteophyte, or disc resection for decompression was done.Materials and Methods:Sixty-four patients having multisegmental cervical spondylosis who presented with symptoms of severe myelopathy were surgically treated during the period from March 2013 to December 2018. On the basis of the concept that instability is the primary cause of spinal degeneration, multisegmental spinal fixation was done in all patients. Atlantoaxial joint was included in the fixation construct in 48 patients. The levels of spinal fixation were determined on the basis of direct observation of facet joints and by manual manipulation and were guided by the presenting clinical features and radiological information. Clinical monitoring was done using Goel clinical grading, modified Japanese Orthopedic Association Score, and visual analog score parameters. Patient satisfaction index assessed the functional and symptomatic improvement.Results:During the follow-up that ranged from 6 to 75 months, all patients improved in their clinical status. Fifty-five (85.9%) patients could walk independently or with mild support.Conclusions:Multisegmental spinal fixation that includes atlantoaxial joint in most patients forms a rational treatment strategy for patients of cervical spondylosis presenting with severe symptoms of myelopathy.

show abstract

Outcomes of Surgical Decompression in Patients With Very Severe Degenerative Cervical Myelopathy

Abstract: 2.

Cited by 25 publications

References 17 publications

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Radiological and Clinical Outcome after Multilevel Anterior Cervical Discectomy and/or Corpectomy and Fixation

Reweighting of the sensory inputs for postural control in patients with cervical spondylotic myelopathy after surgery

Cervical spondylosis in patients presenting with “severe” myelopathy: Analysis of treatment by multisegmental spinal fixation – A case series

Contact Info

Product

Resources

About