Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically

Kadaňka, Zdeněk; Mareš, Miroslav; Bednařík, Josef; Smrčka, Vladimír; Krbec, Martin; Chaloupka, Richard; Dušek, Ladislav

doi:10.1111/j.1468-1331.2004.00947.x

Cited by 53 publications

(42 citation statements)

References 28 publications

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“…At 6 months, 9 patients were nonresponders, 24 were responders, and 6 were very good responders, At 36 months, 8 were nonresponders, 22 were responders, and 7 were very good responders. 10 The average mJOA scale score improved from 14.6 to 14.7 (95% CI 14.0-15.3). The 10-m walk times stayed similar at 7.4-7.5 seconds (95% CI 6.7-8.4).…”

Section: Longitudinal Analysis With Outcome Measuresmentioning

confidence: 99%

The natural history of cervical spondylotic myelopathy

Matz

Anderson²,

Holly

et al. 2009

SPI

194

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Object The objective of this systematic review was to use evidence-based medicine to delineate the natural history of cervical spondylotic myelopathy (CSM) and identify factors associated with clinical deterioration. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to the natural history of CSM. Abstracts were reviewed and studies meeting the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. Results The natural history of CSM is mixed: it may manifest as a slow, stepwise decline or there may be a long period of quiescence (Class III). Long periods of severe stenosis are associated with demyelination and may result in necrosis of both gray and white matter. With severe and/or long lasting CSM symptoms, the likelihood of improvement with nonoperative measures is low. Objectively measurable deterioration is rarely seen acutely in patients younger than 75 years of age with mild CSM (modified Japanese Orthopaedic Association scale score > 12; Class I). In patients with cervical stenosis without myelopathy, the presence of abnormal electromyography findings or the presence of clinical radiculopathy is associated with the development of symptomatic CSM in this patient population (Class I). Conclusions The natural history of CSM is variable, which may affect treatment decisions.

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Section: Longitudinal Analysis With Outcome Measuresmentioning

confidence: 99%

The natural history of cervical spondylotic myelopathy

Matz

Anderson²,

Holly

et al. 2009

SPI

194

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“…Cervical spondylotic myelopathy is a frequent and treatable cause of cervical myelopathy [1]. Although surgery is generally indicated for patients with severe motor deficits or significant functional disturbance, there is no agreement as to the best approach and reconstruction technique especially for multilevel spondylotic myelopathy.…”

Section: Introductionmentioning

confidence: 99%

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Zaïri

Aboukaïs²,

Thines³

et al. 2012

Eur Spine J

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Background In patients with cervical spondylotic myelopathy, ventral disease and loss of physiological cervical lordosis are indications for anterior approach. As bone graft and titanium cage present many drawbacks, expandable titanium cage has been recently introduced for this indication. The authors present the clinical and radiological outcomes in patients undergoing the placement of an expandable cage in the treatment of spondylotic myelopathy with straight or kyphotic cervical spine alignment. Methods This was a retrospective review of prospectively collected data. A total of 26 patients underwent cervical corpectomy and reconstruction using an expandable titanium cage and anterior plate between 2005 and 2008. Pain and functional disability were measured using VAS and mJOA preoperatively and at 3 months, 6 months, 1 year and 2 years. Kyphosis was measured using lateral radiographs at the same points of follow-up. Fusion was evaluated on flexion-extension radiographs at 2 years. Results The mean VAS improved from 4.2 to 1.7 and the mean mJOA increased from 12.85 to 16.04 at 2 years postoperatively (p \ 0.05). The mean kyphosis angle decreased from 17°to 2°at the last follow-up (p \ 0.05). The fusion rate was 100 % at 2 years. Three complications were reported including a transient dysphagia, an epidural hematoma and an early hardware migration.Conclusion Expandable titanium cage is an effective device, which achieves good clinical and radiological outcomes at a minimum 2-year follow-up.

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“…The complication rate is not insignificant, particularly in the elderly. These issues, combined with the fact that CSM may stabilize clinically in a subset of patients without surgery, 11 increases the importance of prospectively determining which patients are most likely to benefit from surgical intervention.…”

mentioning

confidence: 99%

Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

Holly

Matz

Anderson³

et al. 2009

SPI

105

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Object The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery. Methods The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to clinical preoperative factors. Abstracts were reviewed, and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III). Conclusions Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.

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Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically

Cited by 53 publications

References 28 publications

The natural history of cervical spondylotic myelopathy

The natural history of cervical spondylotic myelopathy

Relevance of expandable titanium cage for the treatment of cervical spondylotic myelopathy

Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

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