Long-Term Sustainability of Functional Improvement Following Central Corpectomy for Cervical Spondylotic Myelopathy and Ossification of Posterior Longitudinal Ligament

Abstract OBJECTIVE: We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients. METHODS: Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30–67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (≤50 yr or >50 yr), grade before surgery (4 or 5), the number of levels operated (1 or >1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (≤12 mo or >12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1). RESULTS: The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P < 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure. CONCLUSION: More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM.

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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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Posterior Uveal Effusion after Cataract Surgery

Case Reports in Ophthalmology ◽

10.1159/000510390 ◽

2021 ◽

pp. 62-67

Author(s):

Annegret Abaza ◽

Özlem Dikmetas ◽

Irmingard Neuhann ◽

Faik Gelisken

Keyword(s):

Cataract Surgery ◽

Corticosteroid Therapy ◽

Anterior Segment ◽

Subretinal Fluid ◽

Posterior Pole ◽

Functional Improvement ◽

Long Term Observation ◽

The Right ◽

Uveal Effusion

We report a case of posterior uveal effusion (UE) with a long-term follow-up that has occurred following cataract surgery. A 64-year-old woman presented with diminished vision of the right eye (RE) 3 weeks after an uneventful phacoemulsification and intraocular lens implantation. Complete ophthalmic examination including fluorescein angiography (FA), indocyanine green angiography (ICGA), echography and optical coherence tomography (OCT) were performed. Best corrected visual acuity (BCVA) of the RE was 20/50. Anterior segment and intraocular pressure were unremarkable. OCT revealed prominent folds of the choroid and retina, subretinal fluid and darkening of the choroid with reduced visibility of the choroidal vessels and the scleral border. The left eye (LE) was unremarkable. BCVA of the LE was: 20/20. After topical anti-inflammatory and systemic corticosteroid therapy for 5 months, no morphological change of the macula was seen. The patient was observed without any treatment. Forty-three months after the cataract surgery and 38 months after cessation of the corticosteroid therapy, OCT revealed a normal macular morphology and the BCVA improved to 20/25. Even though rare, UE at the posterior pole may occur after modern cataract surgery. OCT examination is a reliable tool in monitoring the macular morphology. Since morphological and functional improvement can be seen in long-term, observation may be considered for some cases of posterior UE with resistance to the therapy.

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Predictors of functional recovery following surgery for foot drop due to degenerative lumbar disease

Journal of Neurosurgery Spine ◽

10.3171/2021.5.spine21350 ◽

2021 ◽

pp. 1-6

Author(s):

Assaf Berger ◽

Laurence Mangel ◽

Sharif Basal ◽

Zvi Lidar ◽

Gilad J Regev ◽

...

Keyword(s):

Functional Recovery ◽

Postoperative Period ◽

Univariate Analysis ◽

Degenerative Disease ◽

Foot Drop ◽

Functional Improvement ◽

Lumbar Degenerative Disease ◽

Motor Weakness ◽

Short And Long Term

OBJECTIVE Surgery for foot drop secondary to lumbar degenerative disease is not always associated with postoperative functional improvement. It is still unclear whether early decompression results in better functional recovery and how soon surgery should be performed. This study aimed to evaluate predicting factors that affect short- and long-term recovery outcomes and to explore the relationship between timing of lumbar decompression and recovery from foot drop in an attempt to identify a cutoff time from symptom onset until decompression for optimal functional improvement. METHODS The authors collected demographic, clinical, and radiographic data on patients who underwent surgery for foot drop due to lumbar degenerative disease. Clinical data included tibialis anterior muscle (TAM) strength before and after surgery, duration of preoperative motor weakness, and duration of radicular pain until surgery. TAM strength was recorded at the immediate postoperative period and 1 month after surgery while long-term follow-up on functional outcomes were obtained at ≥ 2 years postsurgery by telephone interview. Data including degree and duration of preoperative motor weakness as well as the occurrence of pain and its duration were collected to analyze their impact on short- and long-term outcomes. RESULTS The majority of patients (70%) showed functional improvement within 1 month postsurgery and 40% recovered to normal or near-normal strength. Univariate analysis revealed a trend toward lower improvement rates in patients with preoperative weakness of more than 3 weeks (33%) compared with patients who were operated on earlier (76.5%, p = 0.034). In a multivariate analysis, the only significant predictor for maximal strength recovery was TAM strength before surgery (OR 6.80, 95% CI 1.38–33.42, p = 0.018). Maximal recovery by 1 month after surgery was significantly associated with sustained long-term functional improvement (p = 0.006). CONCLUSIONS Early surgery may improve the recovery rate in patients with foot drop caused by lumbar degenerative disease, yet the strongest predictor for the extent of recovery is the severity of preoperative TAM weakness. Maximal recovery in the short-term postoperative period is associated with sustained long-term functional improvement and independence.

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Grafting of Encapsulated Dopamine-Secreting Cells in Parkinson's Disease: Long-Term Primate Study

Cell Transplantation ◽

10.1177/096368970000900519 ◽

2000 ◽

Vol 9 (5) ◽

pp. 705-709 ◽

Cited By ~ 41

Author(s):

Isao Date ◽

Tetsuro Shingo ◽

Hideyuki Yoshida ◽

Kenjiro Fujiwara ◽

Kazuki Kobayashi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Pc12 Cells ◽

Tumor Formation ◽

Functional Improvement ◽

Functional Changes ◽

Polymer Encapsulation ◽

Encapsulated Cells ◽

Fluid Analysis

The transplantation of encapsulated dopamine-secreting cells into the striatum represents one potential means of treating Parkinson's disease. The present study investigated the ability of encapsulated PC12 cells, which are derived from rat pheochromocytoma, to supply L-dopa and dopamine into the primate brain in the long term and to effect functional improvement in the animals. Following polymer encapsulation, PC12 cells were transplanted into the striatum of hemiparkinsonian monkeys. The secretion of L-dopa and dopamine from the encapsulated cells, the morphology of these cells, the histology of the host striatum surrounding the capsule, and functional changes in the host animals were examined 1, 6, and 12 months after transplantation. Analysis of retrieved capsules revealed that the PC12 cells survived and continued to release L-dopa and dopamine even 12 months after transplantation. The histological response of the host brain surrounding the capsules was minimal and there were no signs of immunological rejection or tumor formation. The physical condition of the host animals was good for 12 months, and hematologic and cerebrospinal fluid analysis revealed that no animals suffered from infection or immunological reaction. These PC12 cell-grafted monkeys showed improvements in hand movements after transplantation, effects that lasted for at least 12 months. These results further support the potential use of this approach for the treatment of Parkinson's disease.

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Long-term functional improvement in hemiplegic patients after stroke: A series of case

Annals of Physical and Rehabilitation Medicine ◽

10.1016/j.rehab.2014.03.089 ◽

2014 ◽

Vol 57 ◽

pp. e25

Author(s):

M. Testud ◽

M. Kerzoncuf ◽

L. Bensoussan ◽

J.M. Viton ◽

A. Delarque

Keyword(s):

Functional Improvement

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A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/91 ◽

2011 ◽

Vol 3;14 (2;3) ◽

pp. 91-121

Author(s):

Laxmaiah Manchikanti

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Systematic Reviews ◽

Randomized Trials ◽

Opioid Therapy ◽

Functional Improvement ◽

Controlled Trials ◽

Chronic Opioid Therapy ◽

Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

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Preservation of C7 spinous process does not influence the long-term outcome after laminoplasty for cervical spondylotic myelopathy

International Orthopaedics ◽

10.1007/s00264-005-0062-y ◽

2006 ◽

Vol 30 (5) ◽

pp. 362-365 ◽

Cited By ~ 16

Author(s):

K. Higashino ◽

S. Katoh ◽

K. Sairyo ◽

T. Sakai ◽

H. Kosaka ◽

...

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Spinous Process ◽

Term Outcome ◽

Long Term Outcome

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Long-term follow-up of the progression of ossification of the posterior longitudinal ligament

Journal of Neurosurgery Spine ◽

10.3171/2010.1.spine09452 ◽

2010 ◽

Vol 12 (5) ◽

pp. 577-579 ◽

Cited By ~ 17

Author(s):

Motoaki Murakami ◽

Atsushi Seichi ◽

Hirotaka Chikuda ◽

Katsushi Takeshita ◽

Kozo Nakamura ◽

...

Keyword(s):

Cervical Spine ◽

Mixed Type ◽

Posterior Longitudinal Ligament ◽

Maturation Process ◽

Initial Stage ◽

Initial Symptoms ◽

Long Term Follow Up

The authors report the case of a man with cervical ossification of the posterior longitudinal ligament (OPLL) who was observed for more than 26 years. Initial symptoms consisted of subtle numbness of the hands, and initial radiography showed small, segmental-type OPLL in the cervical spine. Lateral radiography of the cervical spine was performed every few years. Ossification accelerated for about 4 years during the follow-up. Segmental-type OPLL developed into mixed-type extensive OPLL. This case shows an accelerating maturation process of OPLL over the course of a few years. Segmental-type OPLL appears to represent an initial stage of extensive OPLL.

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