scholarly journals The Natural History of Degenerative Cervical Myelopathy and the Rate of Hospitalization Following Spinal Cord Injury: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 28S-34S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
Spyridon Karadimas ◽  
Jefferson R. Wilson ◽  
Paul M. Arnold ◽  
Shekar Kurpad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Cervical Myelopathy ◽  
Cochrane Collaboration ◽  
Level Of Evidence ◽  
Cord Injury ◽  
History Of ◽  
Degenerative Cervical Myelopathy

Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low.

scholarly journals Nonoperative Versus Operative Management for the Treatment Degenerative Cervical Myelopathy: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 35S-41S ◽  
Author(s):  
John Rhee ◽  
Lindsay A. Tetreault ◽  
Jens R. Chapman ◽  
Jefferson R. Wilson ◽  
Justin S. Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Nonoperative Treatment ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy

Study Design: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease that is increasingly managed surgically. The objective of this study is to determine the role of nonoperative treatment in the management of DCM by updating a systematic review published by Rhee and colleagues in 2013. The specific aims of this review were (1) to determine the comparative efficacy, effectiveness, and safety of nonoperative and surgical treatment; (2) to assess whether myelopathy severity differentially affects outcomes of nonoperative treatment; and (3) to evaluate whether activities or minor injuries are associated with neurological deterioration. Methods: Methods from the original review were used to search for new literature published between July 20, 2012, and February 12, 2015. Results: The updated search yielded 2 additional citations that met inclusion criteria and compared the efficacy of conservative management and surgical treatment. Based on a single retrospective cohort, there were no significant differences in posttreatment Japanese Orthopaedic Association (JOA) or Neck Disability Index scores or JOA recovery ratios between patients treated nonoperatively versus operatively. A second retrospective study indicated that the incidence rate of hospitalization for spinal cord injury was 13.9 per 1000 person-years in a nonoperative group compared with 9.4 per 1000 person-years in a surgical group (adjusted hazard ratio = 1.57; 95% confidence interval = 1.11-2.22; P = .011). Conclusion: Nonoperative management results in similar outcomes as surgical treatment in patients with a modified JOA ≥ 13, single-level myelopathy and intramedullary signal change on T2-weighted magnetic resonance imaging. Furthermore, patients managed nonoperatively for DCM have higher rates of hospitalization for spinal cord injury than those treated surgically. The overall level of evidence for these findings was rated as low.

Prospects of cell replacement therapy for the treatment of degenerative cervical myelopathy

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Graham Ka Hon Shea ◽  
Paul Aarne Koljonen ◽  
Ying Shing Chan ◽  
Kenneth Man Chee Cheung
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Replacement Therapy ◽  
Cervical Myelopathy ◽  
Neurological Function ◽  
Traumatic Spinal Cord Injury ◽  
Cell Replacement Therapy ◽  
Cell Replacement ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy

AbstractDegenerative cervical myelopathy (DCM) presents insidiously during middle-age with deterioration in neurological function. It accounts for the most common cause of non-traumatic spinal cord injury in developed countries and disease prevalence is expected to rise with the aging population. Whilst surgery can prevent further deterioration, biological therapies may be required to restore neurological function in advanced disease. Cell replacement therapy has been inordinately focused on treatment of traumatic spinal cord injury yet holds immense promise in DCM. We build upon this thesis by reviewing the pathophysiology of DCM as revealed by cadaveric and molecular studies. Loss of oligodendrocytes and neurons occurs via apoptosis. The tissue microenvironment in DCM prior to end-stage disease is distinct from that following acute trauma, and in many ways more favourable to receiving exogenous cells. We highlight clinical considerations for cell replacement in DCM such as selection of cell type, timing and method of delivery, as well as biological treatment adjuncts. Critically, disease models often fail to mimic features of human pathology. We discuss directions for translational research towards clinical application.

scholarly journals Increasing awareness of degenerative cervical myelopathy: a preventative cause of non-traumatic spinal cord injury

Spinal Cord ◽  
2021 ◽  
Author(s):  
Carl M. Zipser ◽  
Konstantinos Margetis ◽  
Karlo M. Pedro ◽  
Armin Curt ◽  
Michael Fehlings ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Myelopathy ◽  
Cervical Spinal Cord ◽  
Neurological Impairment ◽  
Common Data Elements ◽  
Cord Injury ◽  
Data Elements ◽  
Degenerative Cervical Myelopathy ◽  
Work Up

AbstractDegenerative cervical myelopathy (DCM) is a common non-traumatic spinal cord disorder and characterized by progressive neurological impairment. Generally, it is still underdiagnosed and referral to spine specialists is often late, when patients already present with incomplete cervical spinal cord injury (SCI). To improve early diagnosis and accelerate referral, diagnostic criteria for DCM are required. Recently, AO Spine RECODE- DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) (aospine.org/recode), an international, interdisciplinary and interprofessional initiative, including patients with DCM, was funded with the aim to accelerate knowledge discovery that can change outcomes. In this perspective we advocate for the participation of SCI specialists in this process, where the expertise and perspective on this disorder and requirements for the diagnostic and therapeutic work up is well developed.

The Natural History of Spinal Cord Injury

2021 ◽  
Vol 32 (3) ◽  
pp. 315-321
Author(s):  
Alexander F. Haddad ◽  
John F. Burke ◽  
Sanjay S. Dhall
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Cord Injury ◽  
History Of

The natural history of complete spinal cord injury: a pooled analysis of 1162 patients and a meta-analysis of modern data

2018 ◽  
Vol 28 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Najib E. El Tecle ◽  
Nader S. Dahdaleh ◽  
Mohamad Bydon ◽  
Wilson Z. Ray ◽  
James C. Torner ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Conversion Rate ◽  
Observational Studies ◽  
Meta Analysis ◽  
Early Surgery ◽  
Cord Injury ◽  
History Of ◽  
Complete Spinal Cord Injury

OBJECTIVEThe natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease.METHODSThe authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis.RESULTSEleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03).CONCLUSIONSThe overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.

scholarly journals Natural History of Isolated Below-Knee Vein Thrombosis in Patients with Spinal Cord Injury

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 861
Author(s):  
Jang-Hyuk Cho ◽  
Dong-Gyu Lee
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Deep Vein Thrombosis ◽  
Natural History ◽  
Vein Thrombosis ◽  
Asian Patients ◽  
Cord Injury ◽  
History Of ◽  
Deep Vein

In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0–74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.

scholarly journals Guidelines for the Management of Degenerative Cervical Myelopathy and Spinal Cord Injury: An Introduction to a Focus Issue

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 6S-7S ◽  
Author(s):  
Michael G. Fehlings ◽  
Brian K. Kwon ◽  
Lindsay A. Tetreault
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Myelopathy ◽  
Guideline Development ◽  
Clinical Expertise ◽  
Guideline Development Group ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy ◽  
Development Group

Study Design: Introduction to a guidelines project. Objectives: The objective of this focus issue is to present guidelines that outline how to best manage patients with degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). Topics addressed in this focus issue include: 1) management strategies for patients with mild, moderate and severe DCM; and 2a) timing of surgical decompression; b) the use of methylprednisolone sodium succinate; c) the type and timing of anticoagulation strategies; d) the role of magnetic resonance imaging in clinical decision making and outcome prediction; and e) the type and timing of rehabilitation in patients with SCI. Methods: Systematic reviews were conducted to address key clinical questions and to synthesize the current body of evidence. A multidisciplinary guideline development group used the results of these reviews, along with their clinical expertise, to develop clinical practice guidelines, in a process that adhered to methodology proposed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group. Results: The multidisciplinary guideline development group combined the systematic review findings with their clinical expertise and opinions to formulate recommendations on how to manage patients with DCM and SCI. Conclusions: These guidelines will serve as tools to assist clinicians in their decision making by offering a perspective that combines the available evidence, expertise from a variety of clinicians, and patient values.

scholarly journals Guidelines for the Management of Degenerative Cervical Myelopathy and Acute Spinal Cord Injury: Development Process and Methodology

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 8S-20S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
Andrea C. Skelly ◽  
Joseph R. Dettori ◽  
Jefferson R. Wilson ◽  
Allan R. Martin ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Practice ◽  
Patient Care ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Cervical Myelopathy ◽  
Institute Of Medicine ◽  
Cord Injury ◽  
Degenerative Cervical Myelopathy

The Institute of Medicine defines clinical practice guidelines as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.” Guidelines help clinicians implement best evidence into practice and encourage informed shared decision making with patients. Guidelines are intended to enhance the quality of patient care by discouraging ineffective and potentially harmful interventions and standardizing practice. Standards for the development and appraisal of guidelines, such as those proposed by the Institute of Medicine and other organizations, help assure guideline quality and credibility. Primary standards include establishing transparency, managing conflicts of interest, forming a multidisciplinary guideline development group, conducting methodologically sound systematic reviews, developing evidence-based recommendations, balancing risks and harms, and rating the strength of recommendations based on the confidence in the evidence. Furthermore, the guideline document must be appraised internally and externally and updated when new evidence arises. The Grading of Recommendation, Assessment, Development and Evaluation process helps appraise the existing body of evidence as well as provide an interactive framework for weighing the benefits and harms of treatment options and translating evidence to recommendations. This article summarizes the methodology used to develop clinical practice guidelines for the management of degenerative cervical myelopathy and acute spinal cord injury.

scholarly journals Spinal obstruction-related versus craniocervical junction related syringomyelia: a comparative study of spinal cord injury

2021 ◽  
Author(s):  
yuan chenghua ◽  
jian guan ◽  
yueqi du ◽  
zeyu fang ◽  
xinyu wang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Scoring Systems ◽  
Craniocervical Junction ◽  
Initial Symptoms ◽  
Cord Injury ◽  
History Of ◽  
The Difference ◽  
Blood Spinal Cord Barrier

Abstract Background No prior reports have focused on spinal cord injury (SCI) characteristics or inflammation after destruction of the blood-spinal cord barrier by syringomyelia. To compare the difference of syringomyelia-related central SCI between craniocervical junction (CCJ) and post-traumatic syringomyelia (PTS) before and after decompression. Methods Between 2015 and 2019, 106 CCJ, 26 CCJ revision and 15 PTS patients (mean history of symptoms 71.5 ± 94.3, 88.9 ± 85.5 and 32.3 ± 48.9 months). The symptom courses were analysed with the ASIA, Klekamp and Samii scoring systems and Kaplan-Meier statistics for neurological changes. The mean follow-up was 20.7 ± 6.2, 21.7 ± 8.8 and 34.8 ± 19.4 months. Results Compared with the other group, the interval time after PTS was longer, but the natural history of syringomyelia was shorter (P=0.0004, 0.0173, respectively). The initial symptoms were usually paraesthesia (P=0.258), and the symptoms were mainly hypoesthesia (P=0.006), abnormal muscle strength (P=0.004), gait (P<0.0001) and abnormal urination (P<0.0001). SCI associated with PTS was more severe than that CCJ related (P=0.003). The cavities in the PTS group were primarily located at the thoracolumbar level, which was different from those in the cervical-thoracic segment at the CCJ. The rate of syrinx/cord was more than 75% (P=0.009), and the intradural adhesions tended to be more severe (P<0.0001). However, there were no significant differences in peripheral blood inflammation markers (PBIM) or long-term clinical efficacy except for the RBC (P=0.042). Conclusion The natural history of PTS tends to progress faster and is more severe than CCJ related. PBIM had no distinguishing effect on the difference in inflammation of syringomyelia except for the RBC. The predictive value of NLR for syringomyelia-related inflammation except in the acute phase was negative.

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