Prediction of the surgical outcome for the treatment of cervical myelopathy by using hyperbaric oxygen therapy

Ishihara, Hirokazu; Matsui, Hisao; Kitagawa, Hideki; Yonezawa, T; Tsuji, Hirokazu

doi:10.1038/sj.sc.3100568

Cited by 7 publications

(4 citation statements)

References 11 publications

(13 reference statements)

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“…8,9 From the standpoint that the brain and spinal cord have very similar histological and physiological properties, the usefulness of HBO therapy for spinal cord injury was investigated in the present study. 10 In addition, there have been some reports on the usefulness of HBO therapy not only on acute spinal cord diseases including a traumatic event reported thereinafter, of course, but also on chronic spinal cord diseases. 11,12 However, concerning the usefulness of HBO therapy, it is also evident that many unclear points remain and some reports described that the ®nal rate of improvement shows no di erence from those obtained by conventional approaches.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury

et al. 2000

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Study design: A retrospective study of spinal cord injury (SCI) treated with and without hyperbaric oxygen (HBO) therapy. Objectives: To report on the use of HBO in spinal cord injury. Setting: Neurosurgical Unit, Tokyo, Japan. Methods: Thirty-four cases of hyperextension spinal cord injury without bone damage and previous history of surgical intervention were divided into two groups, with (HBO) or without (non-HBO) therapy. The neurological ®ndings at admission and their outcomes were evaluated by means of Neurological Cervical Spine Scale (NCSS) 1 and the average improvement rates in individual groups were compared. Results: The improvement rate ranged from 100% to 27.3% with the mean value of 75.2% in the HBO group, while these values were 100%, 25.0% and 65.1% respectively in the non HBO group. Conclusion: In the HBO group, the improvement rate indicated e ectiveness in acute traumatic cervical spinal cord injury. Spinal Cord (2000) 38, 538 ± 540

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Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury

et al. 2000

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“…2 In the surgical management of CSM, careful selection of patients is an important factor affecting clinical outcome. 3 Previous studies have utilised somatosensory evoked potentials, 4,5 magnetic resonance imaging (MRI) changes, 6 computed tomography (CT) myelogram 7 and even hyperbaric oxygen, 8 to correlate with recovery rates, but only after CSM surgery has been performed. However, preoperative prediction of CSM surgical outcome with transcranial magnetic stimulation (TMS) has not been investigated to date.…”

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confidence: 99%

The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy

2007

Ann Acad Med Singap

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Background: Cervical spondylotic myelopathy (CSM) is managed by conservative or surgical measures. While surgery is often performed in cases of longstanding or severe CSM, there is a lack of evidence concerning its efficacy. Transcranial magnetic stimulation (TMS) is a quick, safe, painless and non-invasive technique to study conduction in the descending corticospinal pathways in the spinal cord. The conduction time from the motor cortex to the anterior horn cell [central motor conduction time (CMCT)] is a measure of the integrity of corticospinal pathways. We have previously established the role of TMS in diagnosis and screening of CSM. In this study, we further investigate the use MEPs obtained with TMS in the outcome prediction of severe CSM patients requiring operative intervention. Methods: We prospectively evaluated 46 consecutive patients (mean age, 57.6 years; range, 36 to 84 years; 28 men) presenting with clinical features of CSM over a 2-year period. Disease duration ranged from 6 to 24 months. A total of 45 healthy controls were studied for comparison. All patients underwent clinical scoring. Patients’ initial clinical score (S1) and postoperative scoring at 6 months (S2) were based on a modified Japan Orthopedic Association Scoring Scale. A Modified Recovery Rate (MRR) was calculated based on the formula: (S2 – S1/17 – S1) x 100. We regarded a good surgical outcome as MRR of 50 or above. This was depicted as MRR50. The patients were separated into 4 groups according to the degree of cord compression by degenerative osteo-cartilaginous elements at the most significant level on MRI. TMS studies were performed before surgery. Each investigator was blinded to the results of the other investigators. Results: The upper limb (UL) CMCT (r = -0.507, P <0.0005) and lower limb (LL) CMCT (r = - 0.452, P = 0.002) were significantly and negatively correlated with S1. Similarly, UL MEP amplitude (r = 0.494, P <0005) and LL MEP amplitude (r = 0.305, P = 0.039) were significantly correlated with S1. Surgery consisted of anterior or posterior decompression with cervical laminoplasty, performed by an experienced team of orthopaedic surgeons. No significant intraoperative or postoperative complications were documented. Surgery resulted in significantly improved clinical scoring (unpaired t test, P <0.0005). No correlation between clinical scoring with patients’ age, disease duration, severity or levels of cord compression on MRI was found. ULCMCT and MEP amplitude abnormality were significantly associated with improvement in clinical scoring after surgery (Mann-Whitney test, P <0.05). The UL CMCT was the independent predictor of a good clinical outcome after surgery (odds ratio, 9.09; P = 0.011). Conclusions: In early CSM, lateral corticospinal tracts are first to be affected. It is thus possible that UL CMCT abnormality reflect more severe affectation of the corticospinal tracts placed relatively more medially in the cervical cord. Surgical intervention may have then effectively relieved the clinically significant compression, leading to a better outcome. This was further corroborated by our finding of negative correlation of S1 with UL CMCT, suggesting that patients who were clinically more severe were also electrophysiologically more abnormal, and subsequently benefited more from surgical decompression relative to patients with normal UL CMCT. This the largest series, to our knowledge, showing for the first time that UL CMCT abnormality obtained with TMS is an independent predictor of good surgical outcome in severe CSM. Key words: Cervical spondylosis, Surgery, Severe, Outcome, Transcranial magnetic stimulation, Motor-evoked potential, Magnetic resonance imaging

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“…20 HBO therapy has also been clinically reported to promote neurological recovery after spinal cord injury or surgical treatment of cervical myelopathy. 6,7 We believe that HBO might facilitate the recovery of reversibly injured cells by improving the hypoxic condition of neural tissue at risk, though it has no effect on the recovery of irreversibly injured cells. In the CSA patients of the present study, we speculate that oxygen supply to reversibly injured anterior horn cells under hypoxic conditions by HBO treatment might result in improvement of energy failure and subsequent reinnervation of the atrophic muscles, leading to improvement of muscle strength.…”

Section: Discussionmentioning

confidence: 99%

“…HBO, which is widely performed for patients in hypoxic condition, is an attractive method of treatment that has frequently been used for several neurological diseases. [3][4][5][6][7] HBO therapy has been shown to decrease tissue edema, improve blood flow, and promote oxygen delivery, leading to an increase in the oxygen level in neuronal tissues and enhancement of cellular and metabolic functions. 8 Arterial oxygen pressure and content were increased after HBO treatment, with a 20% improvement of oxygen supply to the ischemic periphery.…”

Section: Discussionmentioning

confidence: 99%

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy

et al. 2011

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Study design: Small case series of patients with cervical spondylotic amyotrophy (CSA) managed by conservative treatment with hyperbaric oxygen (HBO) therapy. Objective: To study the effects of conservative treatment with HBO therapy of CSA patients. Setting: Department of Orthopaedic Surgery, Imakiire General Hospital, Kagoshima, Japan. Methods: This study included 10 patients with CSA who underwent rehabilitation, including cervical traction and muscle exercise, for some period of time but did not respond well to it, and were then managed by additional HBO therapy for rehabilitation. Information was obtained on the duration of symptoms and strength of the most atrophic muscle, intramedullary high-signal-intensity changes on T2-weighted magnetic resonance imaging, presence of 'snake-eyes' appearance and the number of stenotic canal levels. Results: The mean duration of symptoms before HBO treatment was 3.1 months. The axial T2-weighted magnetic resonance images of all 10 patients showed a 'snake-eyes' appearance. The mean number of stenotic canal levels was 0.3. There was marked improvement on manual muscle testing from a mean of 1.9 pretreatment to a mean of 4.4 at the last follow-up after HBO therapy. The outcomes of all 10 patients, whose results were classified as excellent or good, were considered clinically satisfactory. Conclusion: To our knowledge, conservative treatment with HBO therapy for CSA patients has not previously been described. It appears that HBO therapy might improve ischemic injury of the anterior horns in CSA patients with short duration of symptoms.

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Prediction of the surgical outcome for the treatment of cervical myelopathy by using hyperbaric oxygen therapy

Cited by 7 publications

References 11 publications

Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury

Hyperbaric oxygen (HBO) therapy for acute traumatic cervical spinal cord injury

The Role of Electrophysiology in the Diagnosis and Management of Cervical Spondylotic Myelopathy

Conservative treatment with hyperbaric oxygen therapy for cervical spondylotic amyotrophy

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