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

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.

scholarly journals Compensatory cerebral adaptations before and evolving changes after surgical decompression in cervical spondylotic myelopathy

2008 ◽  
Vol 9 (6) ◽  
pp. 538-551 ◽  
Author(s):  
Yun Dong ◽  
Langston T. Holly ◽  
Richard Albistegui-Dubois ◽  
Xiaohong Yan ◽  
Jonathan Marehbian ◽  
...  
Keyword(s):  
Sensorimotor Cortex ◽  
Cervical Spondylotic Myelopathy ◽  
Premotor Cortex ◽  
Japanese Orthopaedic Association ◽  
Clinical Information ◽  
Japanese Orthopaedic Association Score ◽  
Surgical Decompression ◽  
Partial Recovery ◽  
Healthy Controls ◽  
Wrist Extension

Object The goal of this study was to compare cortical sensorimotor adaptations associated with neurological deterioration and then recovery following surgical decompression for cervical spondylotic myelopathy (CSM). Methods Eight patients with CSM underwent functional MR (fMR) imaging during wrist extension and the 3-finger pinch task, along with behavioral assessments before and 3 and 6 months after surgery. Six healthy control volunteers were scanned twice. Results Cervical spine MR imaging demonstrated successful cord decompression. The patients improved after surgery on the modified Japanese Orthopaedic Association score for the upper extremity, which correlated with the changes in task-associated activation in specific sensorimotor regions of interest. Pinch-related activation in sensorimotor cortex contralateral to the movement paradigm was reduced before surgery then increased toward the extent of healthy controls after surgery. Before surgery, patients showed broader activation in ipsilateral sensorimotor cortex during wrist extension than during pinch, but activations became similar to those of healthy controls after surgery. Pinch-related activation volume in the ipsilateral sensorimotor cortex and the magnitude of activation in the contralateral dorsal premotor cortex evolved linearly across time after surgery, along with wrist extension–related activation magnitude in the contralateral supplementary motor area. Conclusions Serial fMR imaging studies in CSM can capture the adaptations in specific sensorimotor cortices that accompany clinical deterioration and postsurgical improvement in sensorimotor function associated with damage and partial recovery of conduction in corticospinal pathways. These adaptive regions can be monitored by serial fMR imaging to detect a critical loss of supraspinal reserve in compensatory plasticity, which might augment clinical information about the need for surgical decompression.

scholarly journals Cervical ossification of the posterior longitudinal ligament and its post surgical outcome analysis

2020 ◽  
Vol 8 (3) ◽  
pp. 816
Author(s):  
Vipul Kumar Gupta ◽  
T. Narsimha Rao
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Tertiary Care ◽  
Disease Process ◽  
Posterior Longitudinal Ligament ◽  
Functional Improvement ◽  
Outcome Analysis ◽  
Biomechanical Factors ◽  
Surgical Group

Background: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre.Methods: This prospective observational study included 35 patients undergoing surgery for cervical OPLL in the department of neurosurgery, Care hospitals Hyderabad from October 2015 to October 2016 with follow up at 3months and 6 months.Results: Total 35 patients who underwent surgery, majority (77.15%) were males and (22.85%) were female. The age of the patients was between 30 to 70 years. The most common type of OPLL was found to be segmental and mixed type. Nurick grade improved by 1.12 in anterior approach vs 0.66 in posterior approach. Recovery rates observed in anterior approach is 57.72% while in posterior surgical approach it is 48.87%. No complication was observed in this study.Conclusions: OPLL is more common in males as compared to females. The average age of presentation is sixth decade. Younger patients have better outcomes. The most common variant of OPLL is segmental.  The recovery rate achieved from anterior approach are better than those from the posterior approach. Improvement in NURICKS score is more in anterior surgical group than in posterior surgical group. No complications seen in this study. No mortality seen in this study.

scholarly journals Surgical Management of Cervical Spondylotic Myelopathy

2012 ◽  
Vol 52 (188) ◽  
Author(s):  
S Sah ◽  
L Wang ◽  
M Dahal ◽  
P Acharya ◽  
R Dwivedi
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Cord Compression ◽  
High Signal ◽  
X Ray ◽  
Surgical Methods ◽  
Physical Examinations ◽  
Anterior Posterior

Introduction: The surgical procedure by the anterior, posterior and combined antero-posterior approaches had applied for the treatment of cervical spondylotic myelopathy.  Methods: During the treatment process, all patients were pre-operatively as well post-operatively graded according to Japanese Orthopaedics Association. Several surgical methods such as anterior approach, posterior approach, and combined antero-posterior approach have been addressed for CSM patients, with the choice based on the pathogenesis of the myelopathy. The main indications for surgery were evidence of myelopathy on physical examinations, a JOA score below 13 points help with spinal cord compression observed on plain X-ray, CT scan, MRI studies.  Results: The pre-operative JOA scores were 7.60±1.23 in laminoplasty, 8.30±1.03 in diskectomy and corpectomy and 7.10±1.20 in combined antero-posterior approach patients. At the follow-up after three months the JOA scores were laminoplasty 13.30±1.30, diskectomy and corpectomy 13.55±1.15 and combined antero-posterior 13.50±1.08. The JOA recovery rate averaged, 61.08±11.25% in laminoplasty, 60.67±10.60% in diskectomy and corpectomy and 64.67±10.72% in combined anteroposterior approach. The high- signal intensity changed to normal in 18 out of 28 and no any kyphotic change and instability were found in cervical spine at the follow up.  Conclusions: Patients with OPLL (continuous, segmental and mixed type), stenosis of cervical spinal canal, multilevel cervical spondylosis, large and high ossification of IVDP with stenosis were improved with laminoplasty. Patients with PIVD, CSM with kyphosis, post laminectomy , OPLL herniated type, unstable vertebral alignment, stenosis by osteophytes, were improved with anterior approach . Ossified or deformed OPLL, unstable vertebral with stenosis ,OPLL or OYL with cervical meandearing (swan-neck) were improved with Combined anterior and posterior approach. Keywords: cervical spondylotic mylopathy, anterior cervical diskectomy and fusion, corpectomy.

scholarly journals CT-Guided Posterolateral Full-Endoscopic Ventral Decompression for Single-Level Cervical Spondylotic Myelopathy

2021 ◽  
pp. E203-E210
Keyword(s):  
Endoscopic Surgery ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Clinical Results ◽  
Foraminal Stenosis ◽  
Ct Guided ◽  
Single Level ◽  
Canal Diameter ◽  
The Mean

BACKGROUND: Percutaneous full-endoscopic surgery was recently developed for the treatment of cervical foraminal stenosis and posterolateral disc herniation. However, there are no studies involving endoscopic surgery to treat cervical spondylotic myelopathy (CSM). OBJECTIVES: To observe the safety, feasibility, and efficacy of posterolateral full-endoscopic ventral decompression (PLEVD) via computed tomography (CT)-guided surgery in patients with single-level CSM. STUDY DESIGN: A prospective cohort study. SETTING: The First Affiliated Hospital of Gannan Medical College. METHODS: From May 2018 to August 2019, 21 patients with single-level CSM underwent CT-guided PLEVD. The posterolateral angle was measured during surgery. The neurologic condition was evaluated via the Japanese Orthopaedic Association (JOA) score and recovery rate, and a Visual Analog Scale (VAS) was used to measure pain relief. The maximum spinal canal diameter (MSCD) was measured on pre- and postoperative CT images. RESULTS: The mean length of follow-up was 11.3 ± 5.3 months. The average posterolateral angle was 36.0° ± 5.6°. The mean VAS score of limbs significantly decreased after surgery. The mean JOA score improved during the follow-up period. Nineteen of the 21 patients achieved good or excellent outcomes, and 2 patients had fair outcomes according to the JOA score 6 months after surgery. The average MSCD was enlarged from 0.55 ± 0.15 cm preoperatively to 1.02 ± 0.18 cm postoperatively. LIMITATIONS: This study was nonrandomized and provides only preliminary clinical results for single-level CSM. CONCLUSION: Under appropriate indications, PLEVD under CT guidance is an available and safe technique for treating single-level CSM. KEY WORDS: CT-guided, posterolateral, full-endoscopic, cervical spondylotic myelopathy

Cementing a collarless polished tapered femoral stem through the anterior approach

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 46-52
Author(s):  
Niall P. McGoldrick ◽  
Daniel Fischman ◽  
Graeme M. Nicol ◽  
Cheryl Kreviazuk ◽  
George Grammatopoulos ◽  
...  
Keyword(s):  
Anterior Approach ◽  
Posterior Approach ◽  
Femoral Stem ◽  
Cement Mantle ◽  
Posterior Group ◽  
Type C ◽  
The Mean ◽  
Hip Arthroplasties ◽  
Anterior Group

Aims The aim of this study was to radiologically evaluate the quality of cement mantle and alignment achieved with a polished tapered cemented femoral stem inserted through the anterior approach and compared with the posterior approach. Methods A comparative retrospective study of 115 consecutive hybrid total hip arthroplasties or cemented hemiarthroplasties in 110 patients, performed through anterior (n = 58) or posterior approach (n = 57) using a collarless polished taper-slip femoral stem, was conducted. Cement mantle quality and thickness were assessed in both planes. Radiological outcomes were compared between groups. Results No significant differences were identified between groups in Barrack grade on the anteroposterior (AP) (p = 0.640) or lateral views (p = 0.306), or for alignment on the AP (p = 0.603) or lateral views (p = 0.254). An adequate cement mantle (Barrack A or B) was achieved in 77.6% (anterior group, n = 45) and in 86% (posterior group, n = 49), respectively. Multivariate analysis revealed factors associated with unsatisfactory cement mantle (Barrack C or D) included higher BMI, left side, and Dorr Type C morphology. A mean cement mantle thickness of ≥ 2 mm was achieved in all Gruen zones for both approaches. The mean cement mantle was thicker in zone 7 (p < 0.001) and thinner in zone 9 for the anterior approach (p = 0.032). Incidence of cement mantle defects between groups was similar (6.9% (n = 4) vs 8.8% (n = 5), respectively; p = 0.489). Conclusion An adequate cement mantle and good alignment can be achieved using a collarless polished tapered femoral component inserted through the anterior approach. Cite this article: Bone Joint J 2021;103-B(7 Supple B):46–52.

Validation of the Surgical Intervention for Traumatic Injury scale in the pediatric population

2020 ◽  
Vol 26 (1) ◽  
pp. 92-97
Author(s):  
David Dornbos ◽  
Christy Monson ◽  
Andrew Look ◽  
Kristin Huntoon ◽  
Luke G. F. Smith ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Pediatric Population ◽  
Traumatic Injury ◽  
Pediatric Trauma ◽  
Current Method ◽  
Clinical Findings ◽  
Surgical Decompression ◽  
Operative Intervention ◽  
Admission Diagnosis ◽  
Communication Tool

OBJECTIVEWhile the Glasgow Coma Scale (GCS) has been effective in describing severity in traumatic brain injury (TBI), there is no current method for communicating the possible need for surgical intervention. This study utilizes a recently developed scoring system, the Surgical Intervention for Traumatic Injury (SITI) scale, which was developed to efficiently communicate the potential need for surgical decompression in adult patients with TBI. The objective of this study was to apply the SITI scale to a pediatric population to provide a tool to increase communication of possible surgical urgency.METHODSThe SITI scale uses both radiographic and clinical findings, including the GCS score on presentation, pupillary examination, and CT findings. To examine the scale in pediatric TBI, a neurotrauma database at a level 1 pediatric trauma center was retrospectively evaluated, and the SITI score for all patients with an admission diagnosis of TBI between 2010 and 2015 was calculated. The primary endpoint was operative intervention, defined as a craniotomy or craniectomy for decompression, performed within the first 24 hours of admission.RESULTSA total of 1524 patients met inclusion criteria for the study during the 5-year span: 1469 (96.4%) were managed nonoperatively and 55 (3.6%) patients underwent emergent operative intervention. The mean SITI score was 4.98 ± 0.31 for patients undergoing surgical intervention and 0.41 ± 0.02 for patients treated nonoperatively (p < 0.0001). The area under the receiver operating characteristic (AUROC) curve was used to examine the diagnostic accuracy of the SITI scale in this pediatric population and was found to be 0.98. Further evaluation of patients presenting with moderate to severe TBI revealed a mean SITI score of 5.51 ± 0.31 in 40 (15.3%) operative patients and 1.55 ± 0.02 in 221 (84.7%) nonoperative patients, with an AUROC curve of 0.95.CONCLUSIONSThe SITI scale was designed to be a simple, objective communication tool regarding the potential need for surgical decompression after TBI. Application of this scale to a pediatric population reveals that the score correlated with the perceived need for emergent surgical intervention, further suggesting its potential utility in clinical practice.

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