Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Xu, Yuan; Chen, Feng; Wang, Yipeng; Zhang, Jianguo; Hu, Jianhua

doi:10.1186/s13018-019-1265-z

Cited by 7 publications

(5 citation statements)

References 45 publications

(44 reference statements)

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“…The aim of MRI is to help diagnose and manage patients earlier, especially those with rp-CSM [ 11 ]. In our study, 88.2% of rp-CSM patients presented with MR T2-hyperintense lesions, which was a risk factor, as reported previously by Morishita et al [ 4 , 5 , 10 – 13 ]. On MRI, T2-hyperintense changes are considered to reflect the pathologies of spinal cord injury, such as edema, gliosis, demyelination, and myelomalacia.…”

Section: Discussionsupporting

confidence: 86%

“…Furthermore, the rp-CSM patients showed good neurological recovery after surgery, indicating that this condition could be reversible. The optimal surgical timing and approach are still controversial and can vary depending on multiple factors, such as the location of the spinal cord compression, affected levels, and patient comorbidities [ 12 , 13 , 15 – 19 ]. In our study, rp-CSM patients had a shorter waiting period to surgery because of rapidly progressive neurological deterioration, and earlier decompression was considered.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

et al. 2021

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Background The rapid progressive cervical spondylotic myelopathy (rp-CSM) which had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration had few reports. Therefore, it is important for us to recognize the pathophysiology of CSM especially the rp-CSM. The study aimed to investigate the risk factors for rapidly progressive (rp) neurological deterioration in patients with cervical spondylotic myelopathy (CSM). Methods A total of 159 patients were reviewed and divided into an rp-CSM group and a chronic-CSM (c-CSM) group. Various clinical indexes, including age, sex, Japanese Orthopaedic Association (JOA) score, intramedullary MR T2-hyperintensity, congenital/degenerative spinal stenosis, and local type of ossification of the posterior longitudinal ligament (OPLL), were analyzed, and independent risk factors were investigated. Results Thirty-four of 159 patients (21.4%) were diagnosed with rp-CSM. All patients were followed up for a mean of 68.56 ± 14.00 months in the rp-CSM group and 62.66 ± 19.95 months in the c-CSM group. No significant difference was found in sex, mean age, smoking and drinking status, diabetes mellitus (DM), hypertension, surgery time, blood loss, JOA score, degenerative spinal stenosis, or OPLL (local). Univariate analyses demonstrated that rp-CSM patients tended to have MR T2-hyperintensity, longer hospital stay, shorter waiting time for surgery, more congenital spinal stenosis, and worse neurological function and to prefer more posterior surgeries than c-CSM patients. A multiple logistic regression analysis showed that congenital spinal stenosis and MR T2-hyperintensity were independently related to the presence of rp-CSM. Conclusions MR T2-hyperintensity and congenital spinal stenosis were risk factors for rp-CSM. Although neurological function deteriorates rapidly, early surgical decompression is recommended and can achieve good neurological recovery after surgery, indicating that rp-CSM could be a reversible condition.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

et al. 2021

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“…One meta-analysis suggested that anterior procedures result in better postoperative neural function than posterior procedures. 17 In addition, Huang et al. 18 revealed that anterior corpectomy had a higher reoperation rate, longer operation time, and greater blood loss.…”

Section: Discussionmentioning

confidence: 99%

“…One meta-analysis suggested that anterior procedures result in better postoperative neural function than posterior procedures. 17 In addition, Huang et al 18 revealed that anterior corpectomy had a higher reoperation rate, longer operation time, and greater blood loss. Liu et al 19 reported that anterior corpectomy and fusion was the preferred treatment for patients with fewer than three surgical segments, and a posterior procedure was recommended for patients with three or more levels of myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of epidural and intradural decompression for treatment of degenerative cervical myelopathy

Jiao

Zhou

et al. 2020

J Int Med Res

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Objective This study was performed to examine the clinical outcomes of epidural and intradural decompression for degenerative cervical myelopathy. Methods The data for 13 patients who underwent epidural and intradural decompression for treatment of degenerative cervical myelopathy (study group) and 20 patients who underwent only cervical laminoplasty, fusion, and epidural decompression (historical control group) were retrospectively reviewed. The preoperative and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) score. Results All patients’ neurological symptoms were significantly improved at the final follow-up. In the study group, the patients’ mean preoperative JOA score was 8.07 ± 1.80, and the final score improved by 70.88% ± 21.18%. The blood loss and operation time were significantly greater in the study group than control group. The recovery time was shorter in the study group than control group. The improvement rate was not significantly different between the two groups. Conclusions A pia mater incision with separation of the arachnoid adhesion can significantly improve the cerebrospinal fluid flow and spinal blood flow in degenerative cervical myelopathy. Arachnoid adhesion can lead to intradural spinal scar compression. The surgical intervention described herein can achieve satisfactory neurological outcomes and shorten the recovery time.

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“…1 However, the diagnosis of degenerative cervical myelopathy is often difficult early in the clinical presentation, predicting progression is complex, and optimal management strategies are unclear. [1][2][3][4][5] Magnetic resonance imaging (MRI) is an important diagnostic imaging modality for degenerative cervical myelopathy in which a hyperintense signal on T2-weighted imaging may represent spinal cord edema or contusion in the setting of acute symptoms, or myelomalacia in the setting of chronic spinal cord damage, 6 and is associated with worse clinical outcomes. 3,[7][8][9] In patients with moderate to severe degenerative cervical myelopathy, decompressive surgery limits neurological deterioration and improves outcomes.…”

mentioning

confidence: 99%

T2-weighted Imaging Hyperintensity and Transcranial Motor-evoked Potentials During Cervical Spine Surgery: Effects of Sevoflurane in 150 Consecutive Cases

LeClair¹,

Ejimone²,

Lynch³

et al. 2023

Journal of Neurosurgical Anesthesiology

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Background: There is debate on the impact of inhalational esthetic agents on transcranial motor evoked potentials (TcMEPs) during intraoperative neuromonitoring. Current guidelines advise their avoidance, which contrasts with common clinical practice.Methods: This retrospective cohort study of 150 consecutive cervical spine surgeries at a single institution compared stimulation voltages and TcMEP amplitudes in patients who did and did not receive sevoflurane as part of a balanced anesthetic technique. Patients were divided into 3 groups stratified by the presence or absence of increased signal intensity within the cervical spinal cord on T2-weighted magnetic resonance imaging (indicative or myelopathy/ spinal cord injury [SCI]) and sevoflurane use.Results: Patients with no magnetic resonance imaging evidence of myelopathy/SCI that received sevoflurane (n = 80) had the lowest stimulation voltages and largest TcMEP amplitude responses in the lower extremities compared with those with no magnetic resonance imaging evidence of myelopathy/SCI (n = 30). In patients with evidence of myelopathy/SCI who did not receive sevoflurane (n = 19), lower extremity TcMEP amplitudes were similar to patients with a myelopathy/SCI that received sevoflurane. Six of these 19 patients had initial low-dose sevoflurane discontinued because of concerns of low/absent baseline TcMEP amplitudes.Conclusions: Balanced anesthesia with 0.5 MAC sevoflurane in patients with and without radiological evidence of myelopathy/ SCI allows reliable TcMEP monitoring. However, in communication with surgical and neuromonitoring teams, it may be advisable in a subset of patients to avoid or discontinue sevoflurane in favor of a propofol/opioid-based anesthetic to ensure adequate and reproducible TcMEPs.

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Surgical approaches and outcomes for cervical myelopathy with increased signal intensity on T2-weighted MRI: a meta-analysis

Cited by 7 publications

References 45 publications

Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

Clinical outcomes of epidural and intradural decompression for treatment of degenerative cervical myelopathy

T2-weighted Imaging Hyperintensity and Transcranial Motor-evoked Potentials During Cervical Spine Surgery: Effects of Sevoflurane in 150 Consecutive Cases

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