Prognostication of Surgical Outcome in Cervical Spondylotic Myelopathy Using Evoked Spinal Cord Potentials

1991 ◽  
pp. 287-295
Author(s):  
K. Shinomiya ◽  
Y. Kurosa ◽  
M. Fuchioka ◽  
H. Sato ◽  
M. Yokoyama ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Outcome ◽  
Cervical Spondylotic Myelopathy

scholarly journals Magnetic resonance imaging predictors of outcome after surgical intervention for cervical spondylotic myelopathy

2020 ◽  
Vol 7 (10) ◽  
pp. 3219
Author(s):  
Sushil Bhogawar ◽  
Prasanth Asher ◽  
Sunilkumar Balakrishnan Sreemathyamma ◽  
Anilkumar Peethambaran
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Surgical Outcome ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Surgical Intervention ◽  
Resonance Imaging ◽  
Group A ◽  
Group B

Background: Cervical spondylotic myelopathy (CSM) is a commonly seen spinal cord disease. There are no well-defined indications and optimal timing for surgical intervention. Therefore, defining predictors for outcome after surgical intervention will have great advantage in taking decisions for interventions.Methods: A consecutive series of all patients having signs and symptoms of cervical spondylotic myelopathy admitted to Department of Neurosurgery, Medical College, Thiruvananthapuram who underwent decompressive surgery with or without stabilization in one year were studied. Pre-operative magnetic resonance imaging (MRI) findings were correlated with post-operative surgical outcomes (Nurick grade) after 3 months of follow up. The pattern of spinal cord signal intensity was classified as: group A (MRI N/N) - no SI T1WI or T2WI, group B (MRI N/Hi) - no SI T1WI and high SI on T2WI and, group C (MRI Lo/Hi) - low SI T1WI and high SI on T2WI. CSM clinical outcomes were evaluated using Nurick grading system, which was used pre- and post-operatively (pre op and post op).Results: Post operatively improvement was seen in 75% of group A and 61.35 % of group B patients, but among group C only 25% patient improved according to Nurick grading pre op and post op.Conclusions: Patients with high intramedullary signal intensity on T2WI may experience a good surgical outcome. A less favorable surgical outcome is predicted by the presence of low intramedullary signal on T1WI.

scholarly journals Remote motor system metabolic profile and surgery outcome in cervical spondylotic myelopathy

2017 ◽  
Vol 26 (6) ◽  
pp. 668-678 ◽  
Author(s):  
Sorin C. Craciunas ◽  
Mircea R. Gorgan ◽  
Bogdan Ianosi ◽  
Phil Lee ◽  
Joseph Burris ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Cervical Spondylotic Myelopathy ◽  
Metabolic Profile ◽  
Motor System ◽  
Clinical Status ◽  
Metabolic Profiles ◽  
Clinical Recovery ◽  
Starting Point

OBJECTIVEIn patients with cervical spondylotic myelopathy (CSM), the motor system may undergo progressive functional/structural changes rostral to the lesion, and these changes may be associated with clinical disability. The extent to which these changes have a prognostic value in the clinical recovery after surgical treatment is not yet known. In this study, magnetic resonance spectroscopy (MRS) was used to test 2 primary hypotheses. 1) Based on evidence of corticospinal and spinocerebellar, rubro-, or reticulospinal tract degeneration/dysfunction during chronic spinal cord compression, the authors hypothesized that the metabolic profile of the primary motor cortices (M1s) and cerebellum, respectively, would be altered in patients with CSM, and these alterations would be associated with the extent of the neurological disabilities. 2) Considering that damage and/or plasticity in the remote motor system may contribute to clinical recovery, they hypothesized that M1 and cerebellar metabolic profiles would predict, at least in part, surgical outcome.METHODSThe metabolic profile, consisting of N-acetylaspartate (NAA; marker of neuronal integrity), myoinositol (glial marker), choline (cell membrane synthesis and turnover), and glutamate-glutamine (glutamatergic system), of the M1 hand/arm territory in each hemisphere and the cerebellum vermis was investigated prior to surgery in 21 patients exhibiting weakness of the upper extremities and/or gait abnormalities. Age- and sex-matched controls (n = 16) were also evaluated to estimate the pre-CSM metabolic profile of these areas. Correlation and regression analyses were performed between preoperative metabolite levels and clinical status 6 months after surgery.RESULTSRelative to controls, patients exhibited significantly higher levels of choline but no difference in the levels of other metabolites across M1s. Cerebellar metabolite levels were indistinguishable from control levels. Certain metabolites—myo-inositol and choline across M1s, NAA and glutamate-glutamine in the left M1, and myo-inositol and glutamate-glutamine in the cerebellum—were significantly associated with postoperative clinical status. These associations were greatly improved by including preoperative clinical metrics into the models. Likewise, these models improved the predictive value of preoperative clinical metrics alone.CONCLUSIONSThese preliminary findings demonstrate relationships between the preoperative metabolic profiles of two remote motor areas and surgical outcome in CSM patients. Including preoperative clinical metrics in the models significantly strengthened the predictive value. Although further studies are needed, this investigation provides an important starting point to understand how the changes upstream from the injury may influence the effect of spinal cord decompression.

scholarly journals Assessing structure and function of myelin in cervical spondylotic myelopathy

Neurology ◽  
2017 ◽  
Vol 89 (6) ◽  
pp. 602-610 ◽  
Author(s):  
Hanwen Liu ◽  
Erin L. MacMillian ◽  
Catherine R. Jutzeler ◽  
Emil Ljungberg ◽  
Alex L. MacKay ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Compression Ratio ◽  
Signal Intensity ◽  
Cervical Spondylotic Myelopathy ◽  
Cord Compression ◽  
Whole Body ◽  
Healthy Controls ◽  
Conventional Mri ◽  
Intensity Compression

Purpose:To assess the extent of demyelination in cervical spondylotic myelopathy (CSM) using myelin water imaging (MWI) and electrophysiologic techniques.Methods:Somatosensory evoked potentials (SSEPs) and MWI were acquired in 14 patients with CSM and 18 age-matched healthy controls. MWI was performed on a 3.0T whole body magnetic resonance scanner. Myelin water fraction (MWF) was extracted for the dorsal columns and whole cord. SSEPs and MWF were also compared with conventional MRI outcomes, including T2 signal intensity, compression ratio, maximum spinal cord compression (MSCC), and maximum canal compromise (MCC).Results:Group analysis showed marked differences in T2 signal intensity, compression ratio, MSCC, and MCC between healthy controls and patients with CSM. There were no group differences in MWF and SSEP latencies. However, patients with CSM with pathologic SSEPs exhibited reduction in MWF (p < 0.05). MWF was also correlated with SSEP latencies.Conclusion:Our findings provide evidence of decreased myelin content in the spinal cord associated with impaired spinal cord conduction in patients with CSM. While conventional MRI are of great value to define the extent of cord compression, they show a limited correlation with functional deficits (i.e., delayed SSEPs). MWI provides independent and complementary readouts to spinal cord compression, with a high specificity to detect impaired conduction.

Clinical Study of Cervical Spondylotic Myelopathy Using Evoked Spinal Cord Potentials

1985 ◽  
pp. 290-301 ◽  
Author(s):  
K.-I. Shinomiya ◽  
K. Furuya ◽  
I. Yamaura ◽  
H. Sato ◽  
A. Kaneda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Clinical Study ◽  
Cervical Spondylotic Myelopathy

scholarly journals MR diffusion tensor imaging of the spinal cord: can it help in early detection of cervical spondylotic myelopathy and assessment of its severity?

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Talaat Ahmed Abd El Hameed Hassan ◽  
Ramy Edward Assad ◽  
Shaimaa Atef Belal
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Early Detection ◽  
Cervical Spondylotic Myelopathy ◽  
Diffusion Tensor ◽  
Cervical Spinal Cord ◽  
Cervical Cord ◽  
Mr Diffusion ◽  
Compressive Myelopathy ◽  
Mr Diffusion Tensor Imaging

Abstract Background The aim of this study is to evaluate the potential application of MR diffusion tensor imaging (with calculation of fractional anisotropy (FA) values) in assessment of the spondylotic cervical spinal canal compromise and comparison with the information issued from conventional MR sequences for early detection of cervical spondylotic myelopathy (CSM). Thirty patients (11 males and 19 females) were included in this study; age ranged from 22 to 70 years (mean age = 44). All patients had conventional and diffusion tensor imaging (DTI) examinations of the cervical spine for detection and assessment of degree of cervical cord myelopathy. FA values of the whole cord circumference and at 3, 6, 9, 12 o’clock positions of the normal cord (opposite to C2), opposite to the most affected disc, and below the level of the most affected disc were measured. Results High statistically significant P values were obtained when comparing the FA values of the normal cord with the cord opposite to the most affected disc, the normal cord with the cord below the affected disc and the cord at the level of the most affected disc with the cord below the level of the most affected disc. Conclusions DTI of the cervical spinal cord with FA measurement in patients with cervical spondylosis helps in early detection of cervical cord compressive myelopathy prior to appearance of changes in conventional MRI, which can improve the clinical outcome and help in treatment plans.

Stress Distribution of the Spinal Cord and Clinical Relevance in Cervical Spondylotic Myelopathy

2014 ◽  
pp. 311-321
Author(s):  
Kohei Takahashi ◽  
Hiroshi Ozawa ◽  
Naoya Sakamoto ◽  
Yuka Minegishi ◽  
Masaaki Sato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Stress Distribution ◽  
Clinical Relevance ◽  
Cervical Spondylotic Myelopathy

scholarly journals Isolated Spinal Cord Arteritis

1975 ◽  
Vol 2 (2) ◽  
pp. 143-146 ◽  
Author(s):  
Thomas E. Feasby ◽  
Gary G. Ferguson ◽  
J.C.E. Kaufmann
Keyword(s):  
Spinal Cord ◽  
Differential Diagnosis ◽  
Erythrocyte Sedimentation Rate ◽  
Laboratory Study ◽  
Sedimentation Rate ◽  
Polyarteritis Nodosa ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Vascular Lesions ◽  
Erythrocyte Sedimentation

SUMMARY:This patient presented as a subacute progressive cervical myelopathy and the differential diagnosis included cervical spondylotic myelopathy and intramedullary mass. Microscopically, vascular lesions plus a patchy myelomalacia indicated a vasculitis. However, there was no suggestion of a generalized vasculitis at autopsy and the only supporting laboratory study was a raised erythrocyte sedimentation rate. It would seem that a vasculitis similar to polyarteritis nodosa or other collagen disease may be confined to the spinal cord.

scholarly journals Reliability of pre-operative diffusion tensor imaging parameter measurements of the cervical spine in patients with cervical spondylotic myelopathy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Eugene Lee ◽  
Joon Woo Lee ◽  
Yun Jung Bae ◽  
Hyo Jin Kim ◽  
Yusuhn Kang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Diffusion Tensor Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Diffusion Tensor ◽  
Intraclass Correlation ◽  
Measurement Methods ◽  
Retest Reliability ◽  
Observer Reliability ◽  
Spinal Cord Level ◽  
Test Retest Reliability

Abstract The present study assessed test–retest and inter-observer reliability of diffusion tensor imaging (DTI) in cervical spondylotic myelopathy (CSM), as well as the agreement among measurement methods. A total 34 patients (12 men, 22 women; mean age, 58.7 [range 45–79] years) who underwent surgical decompression for CSM, with pre-operative DTI scans available, were retrospectively enrolled. Four observers independently measured fractional anisotropy (FA) values twice, using three different measurement methods. Test–retest and inter-observer reliability was assessed using intraclass correlation coefficients (ICCs). Overall, inter-observer agreements varied according to spinal cord level and the measurement methods used, and ranged from poor to excellent agreement (ICC = 0.374–0.821), with relatively less agreement for the sagittal region of interest (ROI) method. The radiology resident and neuro-radiologist group showed excellent test–retest reliability at almost every spinal cord level (ICC = 0.887–0.997), but inter-observer agreements varied from fair to good (ICC = 0.404–0.747). Despite excellent test–retest reliability of the ROI measurements, FA measurements in patients with CSM varied widely in terms of inter-observer reliability. Therefore, DTI parameter data should be interpreted carefully when applied clinically.

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