Surgery for Degenerative Cervical Myelopathy

Gembruch, Oliver; Jabbarli, Ramazan; Rashidi, Ali; Chihi, Mehdi; Hetze, Susann; Barthel, Lennart; Toplak, Adrian; Hindy, Nicolai El; Sure, Ulrich; Dammann, Philipp; Özkan, Neriman

doi:10.1097/brs.0000000000003750

Cited by 19 publications

(20 citation statements)

References 28 publications

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“…A delta score (Δ) was calculated for all PROMs, which was the difference between one-year postoperative and preoperative scores. Patients were grouped based on preoperative mJOA scores, as established by the AO Spine study group: mild (15)(16)(17), moderate (12)(13)(14), and severe (< 12). 4 Patients were subsequently re-grouped based on attainment of MCID.…”

Section: Discussionmentioning

confidence: 99%

Clinical Improvements in Myelopathy Result in Improved Patient Reported Outcomes Following Anterior Cervical Discectomy and Fusion

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Karamian

et al. 2022

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Study Design. Retrospective cohort study. Objective. To determine if myelopathy severity predicted the magnitude of improvement in health-related quality of life metrics following anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Surgery for myelopathy is primarily performed to halt disease progression. However, it is still controversial if these patients can expect significant health-related quality-of life improvements following ACDF. We explore the relationship between modified Japanese Orthopaedic Association (mJOA) improvements and its effect on other health-related quality-of life metrics. Materials and Methods. Patients undergoing ACDF for myelopathy were grouped based on preoperative mJOA scores into mild (15–17), moderate (12–14), and severe (<12) groups. Patients were subsequently categorized based on if they attained the minimum clinically detectable improvement (MCID) threshold for mJOA. Multivariate linear regression was performed to determine the magnitude of improvement in ∆patient-reported outcome measures. Results. A total of 374 patients were identified for inclusion. Of those, 169 (45.2%) had mild myelopathy, 125 (33.4%) had moderate, and 80 (21.4%) had severe myelopathy. Only the moderate and severe groups had significant improvements in mJOA following surgery (mild: P=0.073, moderate: P<0.001, severe: P<0.001). There were no significant differences in the magnitude of improvement for any patient-reported outcome measure based on myelopathy severity, except for mJOA (mild: 0.27, moderate: 1.88, severe: 3.91; P<0.001). Patients meeting the MCID for mJOA had better ∆Short-Form 12 Mental Component Score (3.29 vs. −0.21, P=0.007), ∆Short-Form 12 Physical Component Score (6.82 vs. 1.96, P<0.001), ∆Visual Analog Scale Neck (−3.11 vs. −2.17, P=0.001), ∆Visual Analog Scale Arm (−2.92 vs. −1.48, P<0.001), ∆Neck Disability Index (−18.35 vs. −7.86, P<0.001), and ∆mJOA (3.38 vs. −0.56, P<0.001) compared with patients who did not. Conclusions. Worse baseline myelopathy severity predicts worse postoperative outcomes. However, baseline myelopathy severity is not predictive of the magnitude of postoperative improvement with the exception of mJOA. Patients who attain MCID improvement in mJOA had greater postoperative improvement for other health-related quality of life metrics.

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Section: Discussionmentioning

confidence: 99%

Clinical Improvements in Myelopathy Result in Improved Patient Reported Outcomes Following Anterior Cervical Discectomy and Fusion

Lambrechts

Toci

Karamian

et al. 2022

Spine

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“…The most common symptoms of DCM are cervicobrachial neuralgia, sensory deficits, motor deficits and gait disturbance [1]. Age, preoperative mJOA Score and the high SI on T2-weighted MRI are known to have a negative influence on the postoperative neurological outcome [16][17][18]. Evaluation of the first symptoms and their influence on the neurological outcome could also play an important role in decision making, especially in timing of surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Surgery can improve motor deficits and decrease nursing care requirements among elderly patients with DCM [31]. Therefore, early surgery might be the treatment of choice to interfere the natural history of DCM and improve the neurological prognosis [15,16,18,21].…”

Section: Discussionmentioning

confidence: 99%

“…There is a significant correlation between T2-weighted SI and the degree of spinal cord compression [12,32]. Furthermore, high SI on T2-weighted MRI is known to be a negative predictor for neurological outcome [16,36,37]. For example, Vedantam et al demonstrated that a high SI in T2-weighted MRI is associated with a lower rate on postoperative recovery [38].…”

Section: Discussionmentioning

confidence: 99%

“…Several predictors like duration of symptoms, high signal intensity (SI) on T2-weighted MRI, preoperative modified Japanese Orthopedic Association Score (mJOA Score), age, comorbidities, or smoking status were identified over the recent years to influence the neurological outcome of DCM patients. Interestingly, other factors like the type of stenosis, the number of affected levels, ventral or posterior approach or the type of surgical treatment do not affect the postoperative neurological outcome [13][14][15][16][17][18]. To our best knowledge, first symptom of DCM was not evaluated as a possible predictor of neurological outcome after surgery in detail.…”

Section: Introductionmentioning

confidence: 99%

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First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

et al. 2021

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Purpose Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. Methods A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. Results In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. Conclusion Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.

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Automated signal intensity analysis of the spinal cord for detection of degenerative cervical myelopathy — a matched-pair MRI study

et al. 2023

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Purpose Detection of T2 hyperintensities in suspected degenerative cervical myelopathy (DCM) is done subjectively in clinical practice. To gain objective quantification for dedicated treatment, signal intensity analysis of the spinal cord is purposeful. We investigated fully automated quantification of the T2 signal intensity (T2-SI) of the spinal cord using a high-resolution MRI segmentation. Methods Matched-pair analysis of prospective acquired cervical 3D T2-weighted sequences of 114 symptomatic patients and 88 healthy volunteers. Cervical spinal cord was segmented automatically through a trained convolutional neuronal network with subsequent T2-SI registration slice-by-slice. Received T2-SI curves were subdivided for each cervical level from C2 to C7. Additionally, all levels were subjectively classified concerning a present T2 hyperintensity. For T2-positive levels, corresponding T2-SI curves were compared to curves of age-matched volunteers at the identical level. Results Forty-nine patients showed subjective T2 hyperintensities at any level. The corresponding T2-SI curves showed higher signal variabilities reflected by standard deviation (18.51 vs. 7.47 a.u.; p < 0.001) and range (56.09 vs. 24.34 a.u.; p < 0.001) compared to matched controls. Percentage of the range from the mean absolute T2-SI per cervical level, introduced as “T2 myelopathy index” (T2-MI), was correspondingly significantly higher in T2-positive segments (23.99% vs. 10.85%; p < 0.001). ROC analysis indicated excellent differentiation for all three parameters (AUC 0.865–0.920). Conclusion This fully automated T2-SI quantification of the spinal cord revealed significantly increased signal variability for DCM patients compared to healthy volunteers. This innovative procedure and the applied parameters showed sufficient diagnostic accuracy, potentially diagnosing radiological DCM more objective to optimize treatment recommendation. Trial registration DRKS00012962 (17.01.2018) and DRKS00017351 (28.05.2019)

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Surgery for Degenerative Cervical Myelopathy

Cited by 19 publications

References 28 publications

Clinical Improvements in Myelopathy Result in Improved Patient Reported Outcomes Following Anterior Cervical Discectomy and Fusion

Clinical Improvements in Myelopathy Result in Improved Patient Reported Outcomes Following Anterior Cervical Discectomy and Fusion

First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

Automated signal intensity analysis of the spinal cord for detection of degenerative cervical myelopathy — a matched-pair MRI study

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