scholarly journals The results of surgical treatment for cervical spondylotic myelopathy

2005 ◽  
Vol 52 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Danilo Radulovic ◽  
S. Ivanovic ◽  
M. Jokovic ◽  
G. Tasic
Keyword(s):  
Surgical Treatment ◽  
Cervical Spondylotic Myelopathy ◽  
Intervertebral Disc Degeneration ◽  
Functional Results ◽  
Surgical Decompression ◽  
Grading System ◽  
Operative Complications ◽  
Postoperative Improvement ◽  
Selection Of

Objective: Cervical spondylotic myelopathy is the most serious consequence of cervical intervertebral disc degeneration. The purpose of this study is to evaluate functional results of surgical treatment of patients with cervical spondylotic myelopathy who underwent anterior or posterior decompressive operations. Methods: we prospectively analyzed 57 patients with cervical spondylotic myelopathy who were operated in Institute for Neurosurgery in Belgrade (1995-2002). The severity of myelopathy is graded by Nurick myelopathy grading system. The average follow-up period was 20 months. Results: Postoperative improvement showed 75% of patients and 21% remained unchanged. Myelopathy worsening was observed in two patients, 4%. We didn't have serious operative complications. Selection of surgical approach was not significantly correlated with surgical outcome. Conclusion: surgical decompression of cervical medulla is safe treatment that gives good chances for functional recovery in patients with cervical spondylotic myelopathy.

scholarly journals Anterior versus posterior approach to treat cervical spondylotic myelopathy, clinical and radiological results with long period of follow-up

2018 ◽  
Vol 6 ◽  
pp. 205031211876619 ◽  
Author(s):  
Ziad A Audat ◽  
Mohammad D Fawareh ◽  
Ahmad M Radydeh ◽  
Moutasem M Obeidat ◽  
Mohannad A Odat ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cervical Spondylotic Myelopathy ◽  
Neck Disability Index ◽  
X Ray ◽  
Local Score ◽  
Radiological Results ◽  
Group Ii ◽  
Neck Disability ◽  
Clinical And Radiological Results

Background: Cervical spondylotic myelopathy increases with age, but not all cases are symptomatic. It is usually diagnosed clinically and radiologically (X-ray and magnetic resonance imaging). Surgical treatment is indicated in severe symptomatic cases, while treatment controversy exists in the presence of less severe cases. Anterior and posterior approaches are generally used for decompression with no significant differences in the results of both. Methods: A total of 287 patients of cervical spondylotic myelopathy were treated at our hospital between January 2004 and December 2015. Only 140 patients were eligible for our study. They had at least 5 years of follow-up using full clinical scores and radiological evaluation. They were divided into two groups: group I with 73 patients (aged 23–79 years) underwent posterior decompression, lateral mass instrumentation, and fusion, while group II with 67 patients (aged 33–70 years) underwent anterior decompression, instrumentation, and fusion. Neck Disability Index, local score, and X-ray were used in the evaluation of the patients. Results: Preoperative mean ± standard deviation of Neck Disability Index of both the groups was 32.06 ± 6.33 and 29.88 ± 5.48, which improved in the last visit (>5 years) to 5.81 ± 7.39 and 2.94 ± 5.48 for groups I and II, respectively (p value <0.05). The local score of groups I and II was (P = 1, F = 21, G = 31, E = 19) and (P = 1, F = 12, G = 36, E = 18), which on discharge day improved to (P = 1, F = 4, G = 12, E = 55) and (P = 0, F = 3, G = 6, E = 58) at last follow-up, respectively. Fusion rate was nearly equal for both the groups during all the follow-up intervals and it was 91.1% and 91.7% in the last follow-up. Conclusion: There were no significant differences in the clinical and radiological results between the anterior and posterior approaches used in the surgical treatment of spondylotic cervical myelopathy. However, statistically significant results of Neck Disability Index of anterior approach were not clinically important and may be due to changes in the size and shape of the neck in group II.

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.

scholarly journals Clinical Efficacy and Imaging Analysis for the Surgical Treatment of Thoracolumbar Infections in Elderly Patients

2021 ◽  
Author(s):  
Yanlong Zhong ◽  
Benyu Tang ◽  
Qi Lai ◽  
Yonghong Sheng ◽  
Chao Li ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Elderly Patients ◽  
Clinical Efficacy ◽  
Short Form ◽  
Effective Measure ◽  
Imaging Results ◽  
Sf 36 ◽  
Operative Complications ◽  
One Year

Abstract BackgroundFew reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients.Methods21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analog scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Results Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P<0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The VAS and SF-36 scores (physical component) were significantly better in the PS group six months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the one-year follow-up. Neurological status in both groups improved post-operatively, and 83% of the patients were satisfied with the results of their operation. Imaging results showed that bone graft fusion improved in both groups at six months, one year and at the final follow-up. ConclusionSurgical treatment can provide satisfactory clinical and imaging results for thoracolumbar infection in patients over 65 years old. Although the incidence of peri-operative complications in the elderly is high, it is controllable and surgical treatment remains a safe and effective measure.

The first experience of using autologous conditioned plasma in the surgery of complete macular ruptures in the Voronezh Regional Clinical Ophthalmological Hospital

2021 ◽  
pp. 140-143
Author(s):  
A.A. Roldugin ◽  
◽  
O.V. Donkareva ◽  
S.Y. Shcherbakov ◽  
◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Treatment ◽  
Clinical Observation ◽  
High Efficiency ◽  
Standard Technique ◽  
Functional Results ◽  
Dark Spot ◽  
High Tech ◽  
Early Results

Purpose. To evaluate the effectiveness of the use of autologous conditioned plasma in the surgical treatment of complete macular ruptures. Material and methods. During 2021, 4 patients with complete macular rupture were operated on at the center of ophthalmic microsurgical high-tech care of the Voronezh Regional Clinical Ophthalmological Hospital using autologous conditioned plasma. The BCVA was 0.01–0.3. The diameter of the macular breaks ranged from 214 to 817 µm. Blood samples were taken from the patients before the operation. Autologous conditioned plasma was prepared by centrifuging the patient's blood in a patented Arthrex ACP (Germany) double-circuit syringe. Surgical treatment was carried out according to the standard technique - microinvasive three-port 25G vitrectomy with removal of the BMR to the extreme periphery and IPM in the central part of the retina. After tamponade of the vitreous cavity with air, autologous conditioned plasma was injected intravitreally into the central and peripheral rupture in several layers until a visual film appeared. The follow-up period for patients after surgical treatment was 2 months. Results. When examining patients after 1 week, the edges of the macular foramen remained closed in all cases. All studied patients noted an improvement in visual functions, the absence of metamorphopsia, a decrease in the dark "spot" in front of the eye, visual acuity ranged from 0.2 to 0.7 (0.5 + 0.2) after surgery for a complete macular rupture, and 0.02 in patients after surgery for recurrent macular rupture. After 1 month, the visual acuity after the full macular rupture was repaired after 1 month was 0.3–0.8 (0.6 ± 0.2), which was significantly higher than the preoperative values, and did not change in the patient with recurrent macular rupture. Two months later - the results of optical coherence tomography and visometry without negative dynamics. Conclusions. The early results of clinical observation confirmed the high efficiency of the use of autologous conditioned plasma in the surgical treatment of complete macular ruptures, which allows to obtain high functional results and anatomical closure of the macular rupture, to increase the efficiency and safety of rehabilitation. Key words: macular rupture, autologous conditioned plasma.

scholarly journals Total Penetrating Keratoplasty: Indications, Therapeutic Approach, and Long-Term Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Katarzyna Krysik ◽  
Ewa Wroblewska-Czajka ◽  
Anita Lyssek-Boron ◽  
Edward A. Wylegala ◽  
Dariusz Dobrowolski
Keyword(s):  
Surgical Treatment ◽  
Penetrating Keratoplasty ◽  
Functional Results ◽  
Line Treatment ◽  
Chemical Burns ◽  
Long Term Follow Up ◽  
Complications Of Surgery ◽  
Corneal Melting

Purpose. Evaluation of the indications, anatomical and functional results, and complications of total penetrating keratoplasty (TPK) in disorders involving whole cornea. Materials and Methods. We analyzed outcomes of the surgical treatment of 47 eyes of 46 patients that underwent TPK. Indications were infectious keratitis, autoimmune disease, injury of the eyeball (mainly chemical burns), and other combined disorders. The surgical technique involved dissection of affected tissues with a margin of 1.0 mm. The size of the corneal graft ranged from 10.0 to 14.0 mm. We analyzed indications, outcomes, and complications of surgery. Results. Final restoration of the ocular integrity and maintenance of the globe were achieved in 27 eyes (57%). More than one surgery was necessary in a total of 29 eyes (62%). The frequency of retransplantations did not vary significantly between the groups with different causes of corneal melting/perforation (63% of eyes with infection, 66% of eyes after trauma and 70% of eyes of patients with autoimmune disorders). Surgical treatment failed in 20 eyes (43%). Evisceration was necessary in 13 eyes (28%), phthisis occurred in 7 cases (15%). Conclusion. TPK should be considered as a last line treatment in huge corneal destruction to restore integrity of the eye globe.

scholarly journals Surgical Treatment of Cervical Spondylotic Myelopathy Leads to Functional Improvement in Hand Strength and Dexterity: A Prospective Quantitative Study

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tyler S Cole ◽  
Kaith K Almefty ◽  
Jakub Godzik ◽  
Randall Hlubek ◽  
Jay D Turner
Keyword(s):  
Surgical Treatment ◽  
Grip Strength ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Functional Improvement ◽  
Pinch Strength ◽  
Japanese Orthopedic Association ◽  
Signal Change ◽  
Spinal Cord Dysfunction ◽  
Postoperative Improvement

Abstract INTRODUCTION Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. The goal of this study was to establish the functional impact of CSM severity on hand function using quantitative testing and evaluate the response to intervention. METHODS A total of 33 consecutive patients planned for surgical treatment of CSM were prospectively enrolled. A licensed occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to assess grip strength, 2) hydraulic pinch gauge test to assess pinch strength, and 3) 9-hole peg test to assess upper extremity dexterity. Tests were performed preoperatively and at 6 to 8 wk postoperatively. Patients were stratified into mild, moderate, and severe myelopathy based on modified Japanese Orthopedic Association (mJOA) score. RESULTS 61% patients underwent anterior approach decompression with mean of 2.9 ± 1.5 levels treated. Preoperative pinch (P < .001) and grip (P = .014) strength were lower in moderate and low mJOA patients compared to high mJOA patients. Significant postoperative improvement was observed in all hand function domains with MCI improvement at 6 wk ranging from 33% of patients in dominant strength tests to 72% of patients in nondominant dexterity tests; patients with moderate baseline mJOA were more likely to have MCI improvement in dominant grip (58.3%) compared to low (30%) and high (9%) mJOA groups (P = .041). Dexterity as measured by mean dominant peg percentile was less than 1 in patients with cord signal change increasing in percentile to 15.7 with only subarachnoid effacement (P = .032). CONCLUSION CSM patients achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated most with preoperative mJOA, however baseline dexterity correlated most with severity of stenosis on MRI. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA were the most likely to have improvement in dominant grip strength postoperatively.

Multiple cervical arcocristectomies for the treatment of cervical spondylotic myelopathy: surgical technique and results

2007 ◽  
Vol 7 (5) ◽  
pp. 503-508 ◽  
Author(s):  
Sergio H. Amaral ◽  
Marcelo N. Silva ◽  
Mauricio Giraldi ◽  
Marcelo B. S. Viterbo ◽  
Clemente A. B. Pereira
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Cervical Spondylotic Myelopathy ◽  
Posterior Approach ◽  
Cervical Stenosis ◽  
Surgical Time ◽  
Multilevel Cervical Stenosis

Object In the surgical treatment of cervical spondylotic myelopathy, a posterior approach is recommended for patients with multilevel cervical stenosis. In this article the authors describe the multiple cervical arcocristectomy technique and results. Methods This surgical technique involves the removal of the upper half of the cervical laminae and was performed in 17 patients between 1997 and 2005 with a mean follow-up of 55 months. Results Sixteen patients showed immediate improvement in myelopathic symptoms, and all of them had long-term improvement with no complications and a relatively short surgical time. Conclusions Multiple cervical arcocristectomy is a surgical technique that offers physiological and biomechanical advantages in the treatment of the spondylotic myelopathy.

scholarly journals Functional outcome assessment for surgical decompression of cervical spondylotic myelopathy

2021 ◽  
Vol 9 (1) ◽  
pp. 70
Author(s):  
Tinu Ravi Abraham ◽  
Ajax John ◽  
P. K. Balakrishnan ◽  
Tom Jose
Keyword(s):  
Spinal Cord ◽  
Functional Outcome ◽  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Functional Results ◽  
Surgical Decompression ◽  
Herniated Disc ◽  
Average Hospital ◽  
Japanese Orthopedic Association ◽  
Cost Effective Treatment

Background: Cervical spondylotic myelopathy (CSM) is one of the most common dysfunctions of spinal cord occurs due to degenerative changes in cervical spine disc and facet joints. It is a form of progressive spine disease including herniated disc and spinal cord stenosis which manifests as changes in gait, skilled hand movements, muscle strength, bladder dysfunction etc. Recent studies and trials have established that surgical decompression of cervical spinal is a cost-effective treatment modality which provide satisfactory functional recovery. This study aimed at the functional outcome of surgical decompression of CSM.Methods: The prospective study of 100 cases of cervical myelopathy for which decompressive surgery was done from August 2020 to August 2021. Results were analysed according to Nuricks and modified Japanese orthopedic association scoring system (MJOA).Results: Seventy one males and 29 females were included in this study with average age was 53 and average hospital stay was 3.55 days. Average pre-op Nurick score was 1.93, while score after 6 months and 1year were 1.44 and 1.15respectively. Average pre-op MJOA score was 13.63, while score after 6 months and 1 year were 14.58 and 15.74 respectively.Conclusions: The functional results of decompressive surgeries for cervical myelopathy are satisfactory. Both anterior and posterior approaches are recommended for multiple cervical myelopathy with comparable outcomes. DM and age was observed as the independent predictor for functional outcome, while, gender and level of disease got less significant predictive value.

Sign in / Sign up

Export Citation Format

Share Document