C2-C3 vertebral disc angle: an analysis of patients with and without cervical spondylotic myelopathy

Abstract Background Neck pain, sensory disturbance and motor dysfunction in most patients suffered cervical spondylotic myelopathy (CSM). For CSM surgery, it is necessary to evaluate preoperative inter-vertebral disc degeneration (IDD) which determines whether to adopt fusion strategy, and postoperative IDD which is one of the main reasons for reoperation. Modified Pfirrmann grading system is commonly used to evaluate IDD. The objective of this study is to evaluate its reliability and reproducibility on cervical IDD in CSM patients, and to explore its clinical application value. Methods/Design: All 165 patients with CSM were enrolled. 6 physicians (3 spine surgeons and 3 radiologists) who have certain clinical experience were selected. They graded cervical inter-vertebral disc according to modified Pfirrmann grading system, we used intra-class correlation coefficient (ICC) and weighted kappa (wκ) to assess the inter- and intra-observer agreement. After 12 weeks, we repeated the analysis. Results The inter-observer reliability of modified Pfirrmann grading system was excellent with ICC value of 0.76 and near perfect with wκ value of 0.82. The intra-observer reproducibility of modified Pfirrmann grading system was excellent with ICC values ranging from 0.80–0.91, and near perfect with wκ values ranging from 0.83–0.92. Conclusion Modified Pfirrmann grading system has excellent inter-observer reliability and intra-observer reproducibility on cervical IDD in CSM. In addition, it indicates a good appliance among spine surgeons and radiologists, clinical and radiological studies applying it should be deemed accurate. Thus, modified Pfirrmann grading system can be widely used as an appropriate instrument in clinical care.

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Clinical-electrophysiological correlations in patients with cervical spondylotic myelopathy

Electroencephalography and Clinical Neurophysiology ◽

10.1016/s0013-4694(97)88855-8 ◽

1997 ◽

Vol 103 (1) ◽

pp. 181

Author(s):

V Lisnic

Keyword(s):

Cervical Spondylotic Myelopathy

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Neuropsychological Improvement in Patients with Cervical Spondylotic Myelopathy after Cervical Laminoplasty

Spinal Surgery ◽

10.2531/spinalsurg.23.305 ◽

2009 ◽

Vol 23 (2) ◽

pp. 305-306

Author(s):

Minoru Hoshimaru ◽

Schun-ichi Kihara ◽

Toru Koizumi ◽

Hiroyuki Yukawa ◽

Shigeo Ueda ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Cervical Laminoplasty

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Residual numbness of the upper extremity after cervical surgery in patients with cervical spondylotic myelopathy

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine191566 ◽

2020 ◽

Vol 33 (6) ◽

pp. 734-741

Author(s):

Masayoshi Iwamae ◽

Akinobu Suzuki ◽

Koji Tamai ◽

Hidetomi Terai ◽

Masatoshi Hoshino ◽

...

Keyword(s):

Neck Pain ◽

Upper Extremity ◽

Cervical Spondylotic Myelopathy ◽

Multivariate Linear Regression Analysis ◽

Vas Score ◽

Radiographic Parameters ◽

Clinical Scores ◽

Sf 36 ◽

Cervical Surgery ◽

Preoperative Factors

OBJECTIVEAlthough numbness is one of the chief complaints of patients with cervical spondylotic myelopathy (CSM), preoperative factors relating to residual numbness of the upper extremity (UE) and impact of the outcomes on cervical surgery are not well established. The authors hypothesized that severe preoperative UE numbness could be a risk factor for residual UE numbness after surgery and that the residual UE numbness could have a negative impact on postoperative outcomes. Therefore, this study aimed to identify the preoperative factors that are predictive of residual UE numbness after cervical surgery and demonstrate the effects of residual UE numbness on clinical scores and radiographic parameters.METHODSThe study design was a retrospective cohort study. The authors analyzed data of 103 patients who underwent cervical laminoplasty from January 2012 to December 2014 and were followed up for more than 2 years postoperatively. The patients were divided into two groups: the severe residual-numbness group (postoperative visual analog scale [VAS] score for UE numbness > 40 mm) and the no/mild residual-numbness group (VAS score ≤ 40 mm). The outcome measures were VAS score, Japanese Orthopaedic Association scores for cervical myelopathy, physical and mental component summaries of the 36-Item Short-Form Health Survey (SF-36), radiographic film parameters (C2–7 sagittal vertical axis, range of motion, C2–7 lordotic angle, and C7 slope), and MRI findings (severity of cervical canal stenosis, snake-eye appearance, severity of foraminal stenosis). Following univariate analysis, which compared the preoperative factors between groups, the variables with p values < 0.1 were included in the multivariate linear regression analysis. Additionally, the changes in clinical scores and radiographic parameters after 2 years of surgery were compared using a mixed-effects model.RESULTSAmong 103 patients, 42 (40.8%) had residual UE numbness. In the multivariate analysis, sex and preoperative UE pain were found to be independent variables correlating with residual UE numbness (p = 0.017 and 0.046, respectively). The severity of preoperative UE numbness did not relate to the residual UE numbness (p = 0.153). The improvement in neck pain VAS score and physical component summary of the SF-36 was significantly low in the severe residual-numbness group (p < 0.001 and 0.040, respectively).CONCLUSIONSForty-one percent of the CSM patients experienced residual UE numbness for at least 2 years after cervical posterior decompression surgery. Female sex and preoperative severe UE pain were the predictive factors for residual UE numbness. The patients with residual UE numbness showed less improvement of neck pain and lower physical status compared to the patients without numbness.

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Anterior decompression and fusion with intervertebral fusion cage(Solis) in treatment of cervical spondylotic myelopathy: an analysis of preliminary effectiveness

Academic Journal of Second Military Medical University ◽

10.3724/sp.j.1008.2010.01143 ◽

2010 ◽

Vol 30 (10) ◽

pp. 1143-1145

Author(s):

Peng YUAN ◽

Hui-lin YANG ◽

Li CHENG

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Anterior Decompression ◽

Intervertebral Fusion ◽

Fusion Cage ◽

Anterior Decompression And Fusion

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A New Posterior Extensor Attachment-Point Reconstruction Technique for Cervical Spondylotic Myelopathy Involving C2 Segment: Clinical Outcome and Safety

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1719102 ◽

2020 ◽

Author(s):

Hai-Yun Yang ◽

Yun-Ge Zhang ◽

Dong Zhao ◽

Gui-Ming Sun ◽

Yi Ma ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Plate Fixation ◽

Japanese Orthopaedic Association ◽

Neurological Dysfunction ◽

Reconstruction Technique ◽

Open Door ◽

Titanium Plate ◽

Attachment Point ◽

Curvature Index ◽

Axial Symptoms

Abstract Background and Study Aim Cervical spondylotic myelopathy (CSM) is a common degenerative disease that mainly occurs in elder patients, leading to different degrees of neurological dysfunction. Spinal cord involvement is mainly distributed at the C3–C7 segments, but it may also involve up to the C2 level. This study aimed to assess the clinical efficacy and safety of open-door laminoplasty using a new extensor attachment-point reconstruction technique for treating CSM involving the C2 segment. Patients and Methods Fifty-nine patients with CSM involving the C2 segment and undergoing open-door laminoplasty were included in this retrospective study. Based on the titanium plate used in the operation, patients were divided into two groups, a reconstructed titanium plate fixation (RPF) group (n = 28) and a conventional titanium plate fixation (CPF) group (n = 31). Improvements in neurological function, cervical range of motion (ROM), cervical curvature index (CCI), preservation of posterior cervical muscle mass, and axial symptoms were compared between the two groups. Results There were no significant differences in operative time and intraoperative blood loss between the groups (p > 0.05). The Japanese Orthopaedic Association (JOA) score significantly increased in both groups postsurgery (p < 0.05); the neurological recovery rate was similar between the two groups (64.1 ± 13.3% vs. 65.9 ± 14.7%, p > 0.05). There was no significant loss of cervical ROM in either group (p > 0.05). The anteroposterior dural sac diameter at the C2 level was significantly enlarged in both groups (p < 0.05). Alternatively, CCI was significantly reduced in the CRP group (p < 0.05) but unchanged in the RPF group (p > 0.05). The cross-sectional area of the posterior cervical muscles was also significantly reduced in the CPF group (p < 0.05) but maintained in the RPF group (p > 0.05). Finally, axial symptoms were more severe in the CPF group than in the RPF group (p < 0.05). Conclusion Laminoplasty is an effective surgical procedure for CSM involving the C2 segment. The reconstructed titanium plate achieved superior maintenance of cervical curvature and reduced both muscle atrophy and severity of axial symptoms compared with titanium conventional plates.

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A Clinicoradiological Assessment following Surgical Intervention in Patients of Cervical Spondylotic Myelopathy: An Institutional Experience

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1726607 ◽

2021 ◽

Author(s):

Maneet Gill ◽

Vikas Maheshwari ◽

Arun Kumar Yadav ◽

Rushikesh Gadhavi

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Anterior Approach ◽

Posterior Approach ◽

Surgical Intervention ◽

Japanese Orthopaedic Association ◽

Surgical Decompression ◽

Functional Improvement ◽

Male Predominance ◽

Canal Diameter ◽

Posterior Group

Abstract Introduction To critically analyze the functional and radiological improvement in patients of cervical spondylotic myelopathy (CSM) who underwent surgical decompression by an anterior or posterior approach. Materials and Methods A retrospective study was conducted in a tertiary-level Armed Forces Hospital from June 2015 to December 2019. Preoperative assessment included a thorough clinical examination and functional and radiological assessment. The surgical decompression was done by an anterior or a posterior approach with instrumented fusion. Anterior approach was taken for single or two-level involvement and posterior approach for three or more cervical levels. The pre and postoperative neurological outcome was assessed by Nurick and modified Japanese Orthopaedic Association (mJOA) score along with measurement of canal diameter and cross-sectional area. Results A total of 120 patients of CSM who underwent surgical decompression were analyzed. Both the groups were comparable and had male predominance. A total of 59 patients underwent surgical decompression by an anterior approach and the remaining 61 patients by the posterior approach. Out of the 59 patients operated by the anterior approach, 30 (50.85%) underwent anterior cervical discectomy and fusion (ACDF); remaining 29 (49.15%) underwent anterior cervical corpectomy and fusion (ACCF). In the posterior group (n = 61), 26 (42.6%) patients underwent laminoplasty and the remaining 35 (57.4%) underwent laminectomy with or without instrument fusion. Sixteen patients out of these underwent lateral mass fixation and the remaining 19 underwent laminectomy. There was functional improvement (mJOA and Nurick grade) and radiological improvement in both subgroups, which were statistically significant (p < 0.0001). Conclusion A prompt surgical intervention in moderate-to-severe cases of CSM either by the anterior or the posterior approach is essential for good outcome.

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