scholarly journals Short-term predictive potential of quantitative assessment of spinal cord impairment in patients undergoing French-door Laminoplasty for degenerative cervical myelopathy: preliminary results of an exploratory study exploiting intraoperative ultrasound data

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Guoliang Chen ◽  
Jiachun Li ◽  
Fuxin Wei ◽  
Qiao Ji ◽  
Wenyuan Sui ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Quantitative Assessment ◽  
Japanese Orthopaedic Association ◽  
Intraoperative Ultrasound ◽  
Cord Compression ◽  
Postoperative Mri ◽  
Degenerative Cervical Myelopathy ◽  
Gray Values

Abstract Background To study the correlation of neurological function in degenerative cervical myelopathy (DCM) patients with quantitative assessment of spinal cord compression and impairment by intraoperative ultrasound imaging (IOUSI). Methods Twenty-three patients who underwent French-Door laminoplasty for multilevel DCM were followed for 6 months. Modified Japanese Orthopaedic Association (mJOA) score and cervical MRI were assessed before surgery and at postoperative 6 months. IOUS, used to guide decompression, were recorded. The anteroposterior diameter (APD) and the gray values of the IOUSI hyperechogenicity of the midsagittal IOUSI at the narrowest level and at the lesion-free level, and the APD and traverse diameter at the traverse maximum compression level of IOUSI were measured. Maximum spinal cord compression (MSCC), compression rate (CR), and IOUSI gray value ratio (Rgray) were calculated. The appearance of preoperative T2W MRI increased signal intensity (ISI), and the signal change rate (SCR) on postoperative T2W MRI of 9 patients were also measured and calculated, and compared with that of IOUSI hyperechogenicity. Results Average mJOA score increased significantly from 11.57 ± 2.67 before surgery to 15.39 ± 1.50 at 6 months after surgery, with an average recovery rate (RR) of 71.11 ± 22.81%. The difference between the appearance of preoperative T2W MRI ISI and IOUSI hyperechogenicity was not significant. Spearman correlation analysis found that the IOUSI Rgray were negatively correlated with the RR of mJOA score with a coefficient of − 0.77, and the IOUSI Rgray was not correlated with the postoperative MRI SCR. Conclusions In DCM patients, the gray values of IOUSI can be measured accurately. The IOUSI Rgray correlated with postoperative neurological recovery significantly.

scholarly journals Study protocol for an observational study of cerebrospinal fluid pressure in patients with degenerative cervical myelopathy undergoing surgical deCOMPression of the spinal CORD: the COMP-CORD study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037332
Author(s):  
Carl Moritz Zipser ◽  
Nikolai Pfender ◽  
Jose Miguel Spirig ◽  
Michael Betz ◽  
Jose Aguirre ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Spinal Cord ◽  
Cerebrospinal Fluid ◽  
Spinal Cord Compression ◽  
Study Protocol ◽  
Cervical Myelopathy ◽  
Fluid Pressure ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Degenerative Cervical Myelopathy

IntroductionDegenerative cervical myelopathy (DCM) is a disabling spinal disorder characterised by sensorimotor deficits of upper and lower limbs, neurogenic bladder dysfunction and neuropathic pain. When suspected, cervical MRI helps to reveal spinal cord compression and rules out alternative diagnoses. However, the correlation between radiological findings and symptoms is weak. Cerebrospinal fluid pressure (CSFP) analysis may complement the appreciation of cord compression and be used for intraoperative and postoperative monitorings in patients undergoing surgical decompression.Methods and analysisTwenty patients diagnosed with DCM undergoing surgical decompression will receive standardised lumbar CSFP monitoring immediately before, during and 24 hours after operation. Rest (ie, opening pressure, CSF pulsation) and stimulated (ie, Valsalva, Queckenstedt’s) CSFP—findings in DCM will be compared with 20 controls and results from CSFP monitoring will be related to clinical and neurophysiological findings. Arterial blood pressure will be recorded perioperatively and postoperatively to calculate spinal cord perfusion pressure and spinal vascular reactivity index. Furthermore, measures of CSFP will be compared with markers of spinal cord compression by means of MR imaging.Ethics and disseminationThe study protocol conformed to the latest revision of the Declaration of Helsinki and was approved by the local Ethics Committee of the University Hospital of Zurich (KEK-ZH number PB-2016-00623). The main publications from this study will cover the CSFP fluid dynamics and pressure analysis preoperative, perioperative and postoperative correlated with imaging, clinical scores and neurophysiology. Other publications will deal with preoperative and postoperative spinal perfusion. Furthermore, we will disseminate an analysis on waveform morphology and the correlation with blood pressure and ECG. Parts of the data will be used for computational modelling of cervical stenosis.Trial registration numberClinicalTrials.gov Registry (NCT02170155).

scholarly journals Biomechanical comparison of spinal cord compression types occurring in Degenerative Cervical Myelopathy

2020 ◽  
pp. 105174
Author(s):  
Simon Lévy ◽  
Guillaume Baucher ◽  
Pierre-Hugues Roche ◽  
Morgane Evin ◽  
Virginie Callot ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Degenerative Cervical Myelopathy ◽  
Biomechanical Comparison

scholarly journals Cervical myelopathy due to neurovascular compression syndrome caused by persistent first intersegmental artery: a case report

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Takuro Endo ◽  
Taku Sugawara ◽  
Naoki Higashiyama
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Anatomical Variation ◽  
Cord Compression ◽  
Burning Sensation ◽  
Motor Dysfunction ◽  
Neurological Deficits ◽  
Left Shoulder ◽  
Neurovascular Compression

Abstract Background Persistent first intersegmental artery (PFIA) is a rare anatomical variation of vertebral arteries and is an asymptomatic finding in most cases. Here we report a rare case of cervical myelopathy caused by spinal cord compression by the PFIA. Case presentation The patient was a 52-year-old man who complained of numbness and burning sensation around the neck and left shoulder area, partial weakness in the left deltoid muscle, right side thermal hypoalgesia, and disturbance of deep sensation since the past 1 year, and the symptoms had gradually worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed spinal cord compression by the left PFIA at the C1/C2 level. Because conservative treatment was ineffective, microvascular decompression (MVD) of the PFIA was performed. The left PFIA was laterally transposed using polytetrafluoroethylene (PTFE) bands and anchored to the dura mater using three PTFE bands. To achieve adequate transposition, the small blood vessels bridging the spinal cord and PFIA and the dorsal root nerve had to be sacrificed. Postoperative T2-weighted MRI showed a small hyperintense region in the lateral funiculus of the spinal cord, but no new neurological deficits were identified. In the early postoperative stage, the patient’s deep sensory impairment and motor dysfunction were improved. His numbness and burning sensation almost disappeared, but slight thermal hypoalgesia remained in the lower limb. Conclusion MVD is an effective treatment for spinal cord compression caused by the PFIA, but further studies are necessary to help address technical difficulties and avoid complications.

scholarly journals Human recombinant erythropoietin improves motor function in rats with spinal cord compression-induced cervical myelopathy

PLoS ONE ◽  
2019 ◽  
Vol 14 (12) ◽  
pp. e0214351
Author(s):  
Takahiro Tanaka ◽  
Hidetoshi Murata ◽  
Ryohei Miyazaki ◽  
Tetsuya Yoshizumi ◽  
Mitsuru Sato ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Motor Function ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Cord Compression ◽  
Recombinant Erythropoietin ◽  
Human Recombinant Erythropoietin

scholarly journals Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

2016 ◽  
Vol 40 (6) ◽  
pp. E5 ◽  
Author(s):  
Aria Nouri ◽  
Allan R. Martin ◽  
David Mikulis ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Structural Changes ◽  
Sagittal Alignment ◽  
Measurement Techniques ◽  
Cord Compression ◽  
Age Related ◽  
Magnetic Resonance Imaging Assessment ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.

scholarly journals Imaging and Electrophysiology for Degenerative Cervical Myelopathy [AO Spine RECODE DCM Research Priority Number 9]

2021 ◽  
pp. 219256822110574
Author(s):  
Allan R. Martin ◽  
Lindsay Tetreault ◽  
Benjamin M. Davies ◽  
Armin Curt ◽  
Patrick Freund ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Tissue Injury ◽  
Quantitative Imaging ◽  
Cord Compression ◽  
Narrative Review ◽  
Imaging Tool ◽  
Spinal Cord Dysfunction ◽  
Degenerative Cervical Myelopathy ◽  
And Function

Study Design Narrative review. Objective The current review aimed to describe the role of existing techniques and emerging methods of imaging and electrophysiology for the management of degenerative cervical myelopathy (DCM), a common and often progressive condition that causes spinal cord dysfunction and significant morbidity globally. Methods A narrative review was conducted to summarize the existing literature and highlight future directions. Results Anatomical magnetic resonance imaging (MRI) is well established in the literature as the key imaging tool to identify spinal cord compression, disc herniation/bulging, and inbuckling of the ligamentum flavum, thus facilitating surgical planning, while radiographs and computed tomography (CT) provide complimentary information. Electrophysiology techniques are primarily used to rule out competing diagnoses. However, signal change and measures of cord compression on conventional MRI have limited utility to characterize the degree of tissue injury, which may be helpful for diagnosis, prognostication, and repeated assessments to identify deterioration. Early translational studies of quantitative imaging and electrophysiology techniques show potential of these methods to more accurately reflect changes in spinal cord microstructure and function. Conclusion Currently, clinical management of DCM relies heavily on anatomical MRI, with additional contributions from radiographs, CT, and electrophysiology. Novel quantitative assessments of microstructure, perfusion, and function have the potential to transform clinical practice, but require robust validation, automation, and standardization prior to uptake.

P90 A systematic review of spinal cord serum and cerebrospinal fluid biomarkers for use in degenerative cervical myelopathy

2019 ◽  
Vol 90 (3) ◽  
pp. e45.3-e46 ◽  
Author(s):  
M Stewart ◽  
S Smith ◽  
B Davies ◽  
P Hutchinson ◽  
M Kotter
Keyword(s):  
Spinal Cord ◽  
High Throughput ◽  
Cervical Myelopathy ◽  
Evidence Base ◽  
Cord Compression ◽  
Response To Treatment ◽  
Csf Biomarkers ◽  
Spinal Cord Damage ◽  
Cerebrospinal Fluid Biomarkers ◽  
Degenerative Cervical Myelopathy

ObjectivesWhilst radiological evidence of compression is the hallmark of degenerative cervical myelopathy [DCM], it is unable to stage or prognosticate. Moreover, asymptomatic spinal cord compression is common and therefore new methods of assessing spinal cord function are required. We aimed to: 1) Evaluate the evidence-base for serum and CSF biomarkers of spinal cord damage in diagnosis, prognosis or predicting response to treatment in DCM 2) Identify serum and CSF biomarkers of spinal cord damage studied in other conditions, which may have relevance to DCM.DesignScoping review.SubjectsHuman only.MethodsA search of MEDLINE and EMBASE was performed. Studies involving DCM patients or biomarkers relevant to spinal cord pathobiology were included.Results852 results were screened, of which 83 were included. 9 studies explored 12 biomarkers in DCM. NFH (n=3), S100b and NSE (n=2) received most study. 74 studies explored a further 118 biomarkers in other conditions; S100b (n=13), NFH (n=11) and GFAP (n=10) received most study. Overall, 72 studies used targeted approaches, in which candidate biomarkers were chosen in advance. 11 used unbiased approaches, in which high throughput analyses identified candidate biomarkers during the study.ConclusionsThe evidence-base for use of biomarkers in DCM is limited. Whilst targeted approaches have identified a number of candidate spinal cord markers, few have shown clinical utility. There is a shift towards investigating panels of multiple markers and unbiased, high-throughput approaches.

scholarly journals Characteristics of Upper Limb Impairment Related to Degenerative Cervical Myelopathy: Development of a Sensitive Hand Assessment (Graded Redefined Assessment of Strength, Sensibility, and Prehension Version Myelopathy)

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. E292-E299 ◽  
Author(s):  
Sukhvinder Kalsi-Ryan ◽  
Lauren E Riehm ◽  
Lindsay Tetreault ◽  
Allan R Martin ◽  
Florentina Teoderascu ◽  
...  
Keyword(s):  
Upper Limb ◽  
Functional Impairment ◽  
Cervical Myelopathy ◽  
Hand Function ◽  
Intraclass Correlation ◽  
Japanese Orthopaedic Association ◽  
Neurological Impairment ◽  
Cord Compression ◽  
Manual Dexterity ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Degenerative cervical myelopathy (DCM) involves spinal cord compression, which causes neurological decline. Neurological impairment in DCM is variable and can involve complex upper limb dysfunction including loss of manual dexterity, hyperreflexia, focal weakness, and sensory impairment. The modified Japanese Orthopaedic Association (mJOA) score relies on the patients’ subjective perceptions, whereas existing objective measures such as strength and sensory testing do not capture subtle changes in dexterity and function. OBJECTIVE 1) To characterize arm and hand function in DCM; and 2) To develop and validate Graded Redefined Assessment of Strength, Sensibility, and Prehension Version-Myelopathy (GRASSP-M), a clinical assessment that quantifies upper limb impairment. METHODS A total of 148 DCM patients (categorized into mild, moderate, and severe based on mJOA grade) and 21 healthy subjects were enrolled. A complete neurological exam, the mJOA, the QuickDASH, grip dynamometry, and the GRASSP-M were administered. RESULTS Strength, sensation, and manual dexterity significantly declined with increasing DCM severity (P ≤ .05). Impairment in hand dexterity showed better discrimination between mild, moderate, and severe DCM categories than strength or sensation. The GRASSP-M was found to be both a reliable (intraclass correlation coefficient >0.75 for intra- and inter-rater reliability) and valid (with both concurrent and construct validity) tool. CONCLUSION These results demonstrate that patients’ subjective reporting of functional status, especially in the mild DCM category, may underrepresent the extent of functional impairment. The GRASSP-M is an objective tool designed to characterize patients’ functional impairment related to the upper limb, which proves useful to diagnose and quantify mild dysfunction, monitor patients for deterioration, and help determine when patients should be treated surgically.

Postlaminectomy cervical spinal cord compression demonstrated by dynamic magnetic resonance imaging

1998 ◽  
Vol 88 (1) ◽  
pp. 155-157 ◽  
Author(s):  
Tetsuya Morimoto ◽  
Hiroyuki Ohtsuka ◽  
Toshisuke Sakaki ◽  
Masahiko Kawaguchi
Keyword(s):  
Spinal Cord ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Spinal Cord Compression ◽  
Cervical Myelopathy ◽  
Cervical Spinal Cord ◽  
Cord Compression ◽  
Neutral Position ◽  
Dynamic Magnetic Resonance ◽  
Canal Stenosis

✓ This 32-year-old man had undergone C3–7 laminectomy for posttraumatic cervical myelopathy associated with spinal canal stenosis. He developed recurrent myelopathy 5 years after the initial operation. Dynamic magnetic resonance (MR) imaging of the cervical spine demonstrated spinal cord compression with diffuse canal stenosis while the neck was in the extended position, whereas no significant stenosis was visualized in the neutral position. Sagittal and axial MR images of the affected levels demonstrated striking changes in the cervical spinal cord configuration. Because of an associated hard osteophyte formation and protruded disc, as well as a hypertrophied posterior longitudinal ligament, an anterior decompression and fusion with plate fixation were performed from C-4 to C-7. The postoperative course was uneventful, with subsequent neurological improvement. It is concluded that dynamic MR imaging aids the search for the cause of recurrent postlaminectomy cervical myelopathy after initial improvement following decompressive surgery.

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