scholarly journals Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Weiyang Zhong ◽  
Lin Wang ◽  
Tianji Huang ◽  
Xiaoji Luo
Keyword(s):  
Risk Factors ◽  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Multiple Logistic Regression Analysis ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Neurological Function ◽  
Neurological Deterioration ◽  
Significant Difference ◽  
T2 Hyperintensity

Abstract Background The rapid progressive cervical spondylotic myelopathy (rp-CSM) which had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration had few reports. Therefore, it is important for us to recognize the pathophysiology of CSM especially the rp-CSM. The study aimed to investigate the risk factors for rapidly progressive (rp) neurological deterioration in patients with cervical spondylotic myelopathy (CSM). Methods A total of 159 patients were reviewed and divided into an rp-CSM group and a chronic-CSM (c-CSM) group. Various clinical indexes, including age, sex, Japanese Orthopaedic Association (JOA) score, intramedullary MR T2-hyperintensity, congenital/degenerative spinal stenosis, and local type of ossification of the posterior longitudinal ligament (OPLL), were analyzed, and independent risk factors were investigated. Results Thirty-four of 159 patients (21.4%) were diagnosed with rp-CSM. All patients were followed up for a mean of 68.56 ± 14.00 months in the rp-CSM group and 62.66 ± 19.95 months in the c-CSM group. No significant difference was found in sex, mean age, smoking and drinking status, diabetes mellitus (DM), hypertension, surgery time, blood loss, JOA score, degenerative spinal stenosis, or OPLL (local). Univariate analyses demonstrated that rp-CSM patients tended to have MR T2-hyperintensity, longer hospital stay, shorter waiting time for surgery, more congenital spinal stenosis, and worse neurological function and to prefer more posterior surgeries than c-CSM patients. A multiple logistic regression analysis showed that congenital spinal stenosis and MR T2-hyperintensity were independently related to the presence of rp-CSM. Conclusions MR T2-hyperintensity and congenital spinal stenosis were risk factors for rp-CSM. Although neurological function deteriorates rapidly, early surgical decompression is recommended and can achieve good neurological recovery after surgery, indicating that rp-CSM could be a reversible condition.

scholarly journals Anterior Controllable Antedisplacement and Fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS): a retrospective study of 45 cases

2019 ◽  
Author(s):  
Xi Luo ◽  
Kaiqiang Sun ◽  
Jingchuan Sun ◽  
Shunmin Wang ◽  
Yuan Wang ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Operation Time ◽  
Significant Difference ◽  
Csf Leakage ◽  
One Year ◽  
Neck Disability ◽  
Multilevel Cervical Spondylotic Myelopathy

Abstract Background To investigate the clinical effect of anterior controllable antedisplacement and fusion (ACAF) technique for the treatment of multilevel cervical spondylotic myelopathy with spinal stenosis (MCSMSS), and compare ACAF with hybrid decompression fixation (HDF). Methods A retrospective analysis of 85 cases with MCSMSS was carried out. 45 patients were treated with ACAF, while 40 patients were treated with HDF. The operation time, intraoperative bleeding volume, postoperative complications, Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, Computed Tomography (CT) transverse measurement, cervical curvature and Kang's grade were compared between two groups. Results The patients were followed up for 12 to 17 months. Compared with HDF, ACAF group achieved better decompression according to CT measurement and Kang’s grade (P < 0.05), and recovered to a greater cervical Cobb’s angle (P < 0.05). However, JOA score and NDI index showed no significant difference one year after surgery (P＞0.05). Additionally, ACAF presented longer operation time and greater intraoperative blood loss (P < 0.05). As to complications, ACAF developed less incidences of cerebrospinal fluid examination (CSF) leakage, neurologic deterioration, epidural hematoma and C5 palsy by comparing with HDF. Conclusions ACAF is an effective method for the treatment of MCSMSS. Compared with HDF, ACAF has the advantages of significant decompression, increasing cervical curvature, and reducing the incidences of complications.

Spinal stenosis due to ossified lumbar lesions

2005 ◽  
Vol 3 (4) ◽  
pp. 262-270 ◽  
Author(s):  
Yoshiharu Kawaguchi ◽  
Takeshi Oya ◽  
Yumiko Abe ◽  
Masahiko Kanamori ◽  
Hirokazu Ishihara ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Neurological Deterioration ◽  
Surgical Results ◽  
Content Type ◽  
Spinal Lesions ◽  
Whole Spine ◽  
Fine Print

Object. Spinal stenosis due to lumbar ossified lesions is a rare pathological entity. The authors retrospectively evaluated the clinical features and surgical results associated with cases involving lumbar ossified lesion—induced stenosis. Methods. Data obtained in 20 surgically treated patients with lumbar hyperostotic spinal stenosis were included. To evaluate the background of the disease, body mass index and general complications were assessed. Whole-spine radiological examination was conducted. The presence of ossification of the posterior longitudinal ligament or ossification of the ligamentum flavum was evaluated. Surgical results were classified according to the Japanese Orthopaedic Association (JOA) scale. In the patients in whom neurological deterioration was observed during follow up, the causes of deterioration were reviewed. Seven patients (35%) were obese and six patients (30%) suffered diabetes mellitus. Twelve patients harbored coexisting cervical and/or thoracic ossified lesions. The overall mean JOA score improved from 10.2 to a peak of 22.5; at last follow-up examination the mean JOA score was 20.9. In female and older patients with a long history of preoperative symptoms, a low preoperative JOA score, and other spinal lesions, recovery tended to be poorer. Recovery was poor in one patient, and neurological deterioration due to coexisting ossified spinal lesions occurred in another patient during the follow-up period. Conclusions. Because coexisting ossified lesions were frequently seen, whole-spine analysis is recommended. Early diagnosis and appropriate treatment are important to achieve a better surgical outcome.

scholarly journals Risk Factors for Cervical Deformity After Posterior Cervical Decompression Surgery: A Multicenter Study

2021 ◽  
pp. 219256822110366
Author(s):  
Shin Oe ◽  
Kenta Kurosu ◽  
Tomohiko Hasegawa ◽  
Satoshi Shimizu ◽  
Go Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Multiple Logistic Regression Analysis ◽  
Vertical Axis ◽  
Posterior Longitudinal Ligament ◽  
Decompression Surgery ◽  
Sagittal Vertical Axis ◽  
Fusion Surgery ◽  
Cervical Deformity ◽  
Significant Difference

Study Design: Retrospective multicenter study. Objective: Posterior decompression surgery for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is a common surgery; however, it can cause postoperative cervical deformity (CD). The purpose of this study was to investigate the risk factors for CD. Methods: The participants were 193 patients underwent laminoplasty or laminectomy for CSM or OPLL. CD was defined as a C2-7 sagittal vertical axis (SVA) ≥ 40 mm or a cervical lordosis angle (CL) ≤ −10°. The participants were divided into 2 groups: NCD (without CD before surgery), CD (with CD before surgery). NCD group was divided based on the presence of CD 1 year after surgery as follows: postoperative CD (PCD) and no PCD (NPCD). Results: There were 153 patients (NCD), 40 (CD), 126 (NPCD), and 27 (PCD). There was significant difference in the number of decompressed lamina (NPCD: PCD = 4.1:4.5), the presence of C2 decompression (2: 11%), and C5 palsy (0: 11%). The risk factors for onset of CD, PCD, and CL ≤ −10° as assessed by multiple logistic regression analysis were preoperative C2-7 SVA ≥ 30 mm (odds ratio [OR]: 19.0), decompression of C2 or C7 lamina (OR 3.1), and preoperative CL ≤ 2° (OR 42.0), respectively. Conclusions: To prevent postoperative CD, it is important to avoid decompression of the C2 or C7 lamina. Moreover, in case with C2-7 SVA ≥ 30 mm or CL ≤ 2° before surgery, it is important to explain the risks and consider adding fusion surgery.

scholarly journals Does Diabetes Affect the Surgical Outcomes in Cases With Cervical Ossification of the Posterior Longitudinal Ligament? A Multicenter Study From Asia Pacific Spine Study Group

2021 ◽  
pp. 219256822199630
Author(s):  
Narihito Nagoshi ◽  
Kota Watanabe ◽  
Masaya Nakamura ◽  
Morio Matsumoto ◽  
Nan Li ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Surgical Outcomes ◽  
Hemoglobin A1c ◽  
Perioperative Complications ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Asia Pacific ◽  
C5 Palsy ◽  
Significant Difference ◽  
The Impact

Study Design: Retrospective multicenter study. Objectives: To evaluate the surgical outcomes of cervical ossification of the posterior longitudinal ligament (OPLL) in diabetes mellitus (DM) patients. Methods: Approximately 253 cervical OPLL patients who underwent surgical decompression with or without fixation were registered at 4 institutions in 3 Asian countries. They were followed up for at least 2 years. Demographics, imaging, and surgical information were collected, and cervical Japanese Orthopaedic Association (JOA) scores and the visual analog scale (VAS) for the neck were used for evaluation. Results: Forty-seven patients had DM, showing higher hypertension and cardiovascular disease prevalence. Although they presented worse preoperative JOA scores than non-DM patients (10.5 ± 3.1 vs. 11.8 ± 3.2; P = 0.01), the former showed comparable neurologic recovery at the final follow-up (13.9 ± 2.9 vs. 14.2 ± 2.6; P = 0.41). No correlation was noted between the hemoglobin A1c level in the DM group and the pre- and postoperative JOA scores. No significant difference was noted in VAS scores between the groups at pre- and postsurgery. Regarding perioperative complications, DM patients presented a higher C5 palsy frequency (14.9% vs. 5.8%; P = 0.04). A similar trend was observed when surgical procedure was limited to laminoplasty. Conclusions: This is the first multicenter Asian study to evaluate the impact of DM on cervical OPLL patients. Surgical results were favorable even in DM cases, regardless of preoperative hemoglobin A1c levels or operative procedures. However, caution is warranted for the occurrence of C5 palsy after surgery.

scholarly journals Incidence and Risk Factors for Neurological Deterioration in Posterior Corrective Surgeries for Severe Angular Kyphotic Deformities: A 10-Year Institutional Retrospective Study

2020 ◽  
pp. 219256822097912
Author(s):  
Kalyan Kumar Varma Kalidindi ◽  
Sulaiman Sath ◽  
Jeevan Kumar Sharma ◽  
Gayatri Vishwakarma ◽  
Harvinder Singh Chhabra
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Neurological Deficit ◽  
Operative Time ◽  
Deformity Correction ◽  
Neurological Deterioration ◽  
Kyphotic Deformity ◽  
Neurological Deficits ◽  
Retrospective Case ◽  
Significant Difference

Study Design: Retrospective case-control study. Objective: Neurological deficit is one of the dreaded complications of kyphotic deformity correction procedures. There is inconsistency in the reports of neurological outcomes following such procedures and only a few studies have analyzed the risk factors for neurological deficits. We aimed to analyze the factors associated with neurological deterioration in severe kyphotic deformity correction surgeries. Methods: We performed a retrospective study of 121 consecutive surgically treated severe kyphotic deformity cases (49 males, 56 females) at a single institute (May 1st 2008 to May 31st 2018) and analyzed the risk factors for neurological deterioration. The demographic, surgical and clinical details of the patients were obtained by reviewing the medical records. Results: 105 included patients were divided into 2 groups: Group A (without neurological deficit) with 92 patients (42 males, 50 females) and Group B (with neurological deficit) with 13 patients (7 males, 6 females) (12.4%). Statistically significant difference between the 2 groups was observed in the preoperative sagittal Cobbs angle (p < 0.0001), operative time (p = 0.003) and the presence of myelopathic signs on neurological examination (p = 0.048) and location of the apex of deformity (p = 0.010) but not in other factors. Conclusions: Preoperative Sagittal Cobbs angle, presence of signs of myelopathy, operative time and location of apex in the distal thoracic region were significantly higher in patients with neurological deterioration as compared to those without neurological deterioration during kyphotic deformity correction surgery. Distal thoracic curve was found to have 4 times more risk of neurological deterioration compared to others.

scholarly journals Comparison of Laminoplasty and Posterior Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

2021 ◽  
Author(s):  
Hiroaki Nakashima ◽  
Shiro Imagama ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Kenichiro Sakai ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Perioperative Complications ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Posterior Fusion ◽  
Postoperative Outcomes ◽  
Intensity Change ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Difference

Abstract This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments showed no significant differences. The overall risk of perioperative complications was lower in LM (odds ratio [OR] 0.40, p = 0.006), and C5 palsy was significantly lower in LM (OR 0.11, p = 0.0002) than in PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients with PF was significantly smaller than in those with LM. However, multivariable logistic regression analysis showed no significant difference in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in LM group than in the PF group (OR 2.73, p = 0.0002). LM and PF for cervical myelopathy due to OPLL resulted in comparable postoperative outcomes at two years after surgery.

scholarly journals Simultaneous Cervical and Lumbar Spine Surgery: Retrospective Analysis of 45 Cases

2019 ◽  
Vol 08 (01) ◽  
pp. 047-052 ◽  
Author(s):  
Amit Aiwale ◽  
Pankajkumar Patel ◽  
Syed Paspala ◽  
T. Murthy
Keyword(s):  
Lumbar Spine ◽  
Spinal Stenosis ◽  
Japanese Orthopaedic Association ◽  
Cost Effective ◽  
Lumbar Spine Surgery ◽  
Neurogenic Claudication ◽  
Cervical Canal ◽  
Canal Stenosis ◽  
Significant Difference ◽  
The Mean

Abstract Background The term ‘tandem spinal stenosis’ (TSS) was first introduced by Dagi et al to describe concurrent symptomatic cervical and lumbar spinal stenosis. A typical clinical picture includes intermittent neurogenic claudication, myelopathy, and polyradiculopathy in both the upper and lower extremities. The incidence of TSS ranges from 0.12 to 28%. Methods We studied patients who presented with tandem canal stenosis and operated cervicolumbar decompression with or without fusion procedures by two separate neurosurgical teams simultaneously from June 2015 to 2017 with follow-up period of minimum 6 months. Results We had 30 (66.66%) male and 15 (33.33%) female patients who underwent simultaneous cervical and lumbar spine surgeries. The average age was 57.8 years (male) and 53.9 years (female). Cervical canal stenosis was graded as per magnetic resonance imaging (MRI) morphological grades of stenosis by Kang et al and lumbar grading, was done as per Schizas et al grading system. The mean duration of complaints in cervical and lumbar compression was 29.54 ± 44.99 months and 30.55 ± 38.11 months, respectively. The mean preoperative Japanese Orthopaedic Association (JOA) score of was 10.46 ± 1.39, whereas the postoperative mean JOA score was 11.93 ± 1.28, and mean preoperative (38.59 ± 16.52) and postoperative (29.22 ± 9.38) Oswestry Disability Index (ODI) scores showed a statistically significant difference (p = 0.0001). Conclusion Patients with TSS are elderly and have associated comorbidities, still simultaneous cervical and lumbar surgery is feasible with the good outcome if you have two neurosurgical teams operating simultaneously and having good other super specialty teams’ support. It can be timesaving and cost effective for patients. Also, it avoids patients from undergoing exposure to two separate surgical and anesthetic stress.

Predictors of Return to Normal Neurological Function After Surgery for Moderate and Severe Degenerative Cervical Myelopathy: An Analysis of A Global AOSpine Cohort of Patients

Neurosurgery ◽  
2019 ◽  
Vol 85 (5) ◽  
pp. E917-E923 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Aria Nouri ◽  
Jonathan Nakhla ◽  
Murray Echt ◽  
Yaroslav Gelfand ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Multiple Logistic Regression Analysis ◽  
Japanese Orthopaedic Association ◽  
Area Under The Curve ◽  
Neurological Function ◽  
International Studies ◽  
Patient Counseling ◽  
Multicenter Studies ◽  
Degenerative Cervical Myelopathy ◽  
Walking Time

Abstract BACKGROUND Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS A total of 51 patients (20.3%) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95% confidence interval [CI], 0.01-0.79; P = .03) and longer walking time on the 30-m walking test (OR 0.95; 95% CI, 0.92-0.99; P = .03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.

scholarly journals Clinical adjacent-segment pathology after central corpectomy for cervical spondylotic myelopathy: incidence and risk factors

2016 ◽  
Vol 40 (6) ◽  
pp. E12 ◽  
Author(s):  
Aditya Vedantam ◽  
Vedantam Rajshekhar
Keyword(s):  
Risk Factors ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Adjacent Segment ◽  
Initial Surgery ◽  
The Mean

OBJECTIVE The goal of this study was to investigate the prevalence and risk factors of clinical adjacent-segment pathology (CASP) following central corpectomy for cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL). METHODS The authors reviewed 353 cases involving patients operated on by a single surgeon with a minimum 12-month follow-up after central corpectomy for CSM or OPLL between 1995 and 2007. Patients with symptoms consistent with CASP at follow-up were selected for the study. The authors analyzed the prevalence and risk factors for CASP after central corpectomy for CSM/OPLL. RESULTS Fourteen patients (13 male, 1 female; mean age 46.9 ± 7.7 years) were diagnosed with symptoms of CASP (3.9% of 353 patients) at follow-up. The mean interval between the initial surgery and presentation with symptoms of CASP was 95.6 ± 54.1 months (range 40–213 months). Preoperative Nurick grades ranged from 2 to 5 (mean 3.5 ± 1.2), and the Nurick grades at follow-up ranged from 1 to 5 (mean 3.0 ± 1.3, p = 0.27). Twelve patients had myelopathic symptoms and 2 had radiculopathy at follow-up. Patients with poorer preoperative Nurick grades had a higher risk for development of CASP (HR 2.6 [95% CI 1.2–5.3], p = 0.01). CONCLUSIONS In the present study, CASP was seen in 3.9% of patients following central corpectomy for CSM/OPLL. The risk of CASP after central corpectomy for CSM/OPLL was higher in patients with poorer preoperative Nurick grades.

Prospective cohort study of mild cervical spondylotic myelopathy without surgical treatment

2012 ◽  
Vol 16 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Masatoshi Sumi ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Shuichi Kaneyama ◽  
Takako Kanatani ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Mr Imaging ◽  
Cervical Spondylotic Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Rank Test ◽  
Imaging Findings ◽  
Significant Difference ◽  
The Mean

Object Because the main pathology of cervical spondylotic myelopathy (CSM) is spinal cord damage due to compression, surgical treatment is usually recommended to improve patient symptoms and prevent exacerbation. However, lack of clarity of prognosis in cases that present with insignificant symptoms, particularly those of mild CSM, lead one to question the veracity of this course of action. The purpose of this study was to elucidate the prognosis of mild CSM without surgical intervention by evaluation of clinical symptoms and MR imaging findings. Methods Sixty cases of mild CSM (42 males and 18 females, average age 57.2 years) presenting with scores of 13 or higher on the Japanese Orthopaedic Association (JOA) scale were treated initially by in-bed Good Samaritan cervical traction without surgery. These patients were enrolled between 1995 and 2003 and followed up periodically until the date of myelopathy deterioration or until the end of March 2009. The deterioration of myelopathy was defined as a decline in JOA score to less than 13 with a decrease of at least 2 points. As a prognostic factor, the authors used their classification of spinal cord shapes at their lateral sides on axial T1-weighted MR imaging. “Ovoid deformity” was classified as a situation in which both sides were round and convex, and “angular-edged deformity” where one or both sides exhibited an acute-angled lateral corner. The duration of follow-up was assessed as the tolerance rate of mild CSM using Kaplan-Meier survival analysis and compared between 2 groups classified by MR imaging findings. Furthermore, differences between groups were analyzed by various applications of the log-rank test. Results Of the initial 60 cases, follow-up records existed for 55, giving a follow-up rate of 91.7% (38 males and 17 females, average age 56.1 years). The mean JOA score at end point was 14.1, which was not statistically different from the mean of 14.5 at the initial visit. Deterioration in myelopathy was observed in 14 (25.5%) of 55 cases, whereas 41 (74.5%) of 55 cases maintained mild extent myelopathy without deterioration through the follow-up period (mean 94.3 months). The total tolerance rate of mild CSM was 70%. However, there was a significant difference in the tolerance rate between the cases with angular-edged deformity (58%) and cases with ovoid deformity (95%; p = 0.049). Conclusions The tolerance rate of mild CSM was 70% in this study, which proved that the prognosis of mild CSM without surgical treatment was relatively good. However, the tolerance rate of the cases with angular-edged deformity was 58%. Therefore, surgical treatment should be considered when mild CSM cases show angular-edged deformity on axial MR imaging, even if patients lack significant symptoms.

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