Cervical myelopathy due to degenerative spondylolisthesis

AbstractTic disorders are common, affecting approximately 0.5 to 1% of children and adolescents. Treatment is required only when symptoms are bothersome or impairing to the patient, so many do not require intervention. However, on occasion tics may cause significant morbidity and are referred to as “malignant.” These malignant tics have resulted in cervical myelopathy, subdural hematoma secondary to head banging, biting of lips leading to infection of oral muscles, self-inflicted eye injuries leading to blindness, skeletal fractures, compressive neuropathies, and vertebral artery dissection. We describe a case of malignant tic disorder, with accompanying video segment, resulting in cervical myelopathy and quadriparesis in a child. We also discuss aggressive management strategies for neurologists to prevent potential lifelong disability. This case emphasizes that these malignant tics must be treated with all due haste to prevent such complications.

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Effects of preoperative obesity and psychiatric comorbidities on minimum clinically important differences for lumbar fusion in grade 1 degenerative spondylolisthesis: analysis from the prospective Quality Outcomes Database registry

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine20296 ◽

2020 ◽

Vol 33 (5) ◽

pp. 635-642

Author(s):

Joseph Laratta ◽

Leah Y. Carreon ◽

Avery L. Buchholz ◽

Andrew Y. Yew ◽

Erica F. Bisson ◽

...

Keyword(s):

Spinal Fusion ◽

Preoperative Diagnosis ◽

Rating Scale ◽

Lumbar Fusion ◽

Degenerative Spondylolisthesis ◽

Leg Pain ◽

Quality Outcomes ◽

Medical Comorbidities ◽

Fusion Procedure ◽

Patient Reported

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

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Comparative analysis of minimally invasive surgical decompression and fusion surgery in the treatment of stable stage i lumbar degenerative spondylolisthesis complicated by spinal stenosis

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2006-02 ◽

2020 ◽

pp. 25-37

Author(s):

Roman Kartavykh ◽

Igor Borshchenko ◽

Gennadiy Chmutin ◽

Andrey Baskov ◽

Vladimir Baskov

Keyword(s):

Spinal Stenosis ◽

Degenerative Spondylolisthesis ◽

Stage I ◽

Fusion Surgery ◽

Unilateral Approach ◽

Microsurgical Decompression ◽

Group B ◽

Lumbar Spondylolisthesis ◽

Stable Stage

Purpose: a comparative analysis of long-term clinical and radiological outcomes of bilateral microsurgical decompression from unilateral approach and open fusion surgery in the treatment of patients with stable stage I lumbar degenerative spondylolisthesis complicated by spinal stenosis. Materials and methods: this study included 83 patients with degenerative stage I lumbar spondylolisthesis, combined with spinal stenosis at one/several levels. Bilateral microsurgical decompression from unilateral approach was performed in group A (n = 41), in group B (n = 42) we used transforaminal lumbar interbody fusion. Results: intraoperative blood loss and operation time significantly prevailed in group B (P < 0,05). Pain in the legs (VAS), Oswestry disability index significantly decreased in both groups in the long-term postoperative period. No statistical difference in these was found in groups A and B (P = 0,59; P = 0,10). Lower back pain in both groups at the follow-up period had a significant difference: in fusion group there was a significantly higher intensity, than in group А (P < 0,001). Assessment of radiological outcomes in group A at the level of spondylolisthesis showed a slight decrease in segment stability: an increase in anteroposterior displacement of the vertebrae by an average of 0,44 mm, the angular difference by 0,77°, an increase in displacement of the vertebral body by 1,30 % (P < 0,05). Conclusion: minimally bilateral microsurgical decompression from unilateral approach is an effective method for treatment of stable stage I degenerative lumbar spondylolisthesis, combined with spinal stenosis, allowing to achieve significant regression of leg pain and disability in the long-term postoperative period. And this method admits to significantly decrease of low back pain, then in fusion surgery, as well as a low risk of postoperative instability and reoperation with instrumentation.

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Surgery of Cervical Myelopathy

10.1007/978-3-642-67605-5 ◽

1980 ◽

Keyword(s):

Cervical Myelopathy

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Effect of Surgical Setting on Hospital-Reported Outcomes for Elective Lumbar Spinal Procedures: Tertiary Versus Community Hospitals

Global Spine Journal ◽

10.1177/2192568219848666 ◽

2019 ◽

Vol 10 (4) ◽

pp. 375-383 ◽

Cited By ~ 1

Author(s):

Tristan B. Weir ◽

Neil Sardesai ◽

Julio J. Jauregui ◽

Ehsan Jazini ◽

Michael J. Sokolow ◽

...

Keyword(s):

Pay For Performance ◽

Linear Regression Analysis ◽

Degenerative Spondylolisthesis ◽

Hospital Costs ◽

Patient Characteristics ◽

Tertiary Hospital ◽

Community Hospitals ◽

Single Level ◽

Significant Difference ◽

Reported Data

Study Design: Retrospective cohort study. Objective: As hospital compensation becomes increasingly dependent on pay-for-performance and bundled payment compensation models, hospitals seek to reduce costs and increase quality. To our knowledge, no reported data compare these measures between hospital settings for elective lumbar procedures. The study compares hospital-reported outcomes and costs for elective lumbar procedures performed at a tertiary hospital (TH) versus community hospitals (CH) within a single health care system. Methods: Retrospective review of a physician-maintained, prospectively collected database consisting of 1 TH and 4 CH for 3 common lumbar surgeries from 2015 to 2016. Patients undergoing primary elective microdiscectomy for disc herniation, laminectomy for spinal stenosis, and laminectomy with fusion for degenerative spondylolisthesis were included. Patients were excluded for traumatic, infectious, or malignant pathology. Comparing hospital settings, outcomes included length of stay (LOS), rates of 30-day readmissions, potentially preventable complications (PPC), and discharge to rehabilitation facility, and hospital costs. Results: A total of 892 patients (n = 217 microdiscectomies, n = 302 laminectomies, and n = 373 laminectomy fusions) were included. The TH served a younger patient population with fewer comorbid conditions and a higher proportion of African Americans. The TH performed more decompressions ( P < .001) per level fused; the CH performed more interbody fusions ( P = .007). Cost of performing microdiscectomy ( P < .001) and laminectomy ( P = .014) was significantly higher at the TH, but there was no significant difference for laminectomy with fusion. In a multivariable stepwise linear regression analysis, the TH was significantly more expensive for single-level microdiscectomy ( P < .001) and laminectomy with single-level fusion ( P < .001), but trended toward significance for laminectomy without fusion ( P = .052). No difference existed for PPC or readmissions rate. Patients undergoing laminectomy without fusion were discharged to a facility more often at the TH ( P = .019). Conclusions: We provide hospital-reported outcomes between a TH and CH. Significant differences in patient characteristics and surgical practices exist between surgical settings. Despite minimal differences in hospital-reported outcomes, the TH was significantly more expensive.

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Spine Treatment Appraisal Report (STAR): Does Riluzole Improve Outcomes in Patients Undergoing Decompression Surgery for Degenerative Cervical Myelopathy?

Global Spine Journal ◽

10.1177/2192568221997401 ◽

2021 ◽

pp. 219256822199740

Author(s):

Joseph R. Dettori

Keyword(s):

Cervical Myelopathy ◽

Decompressive Surgery ◽

Decompression Surgery ◽

Phase 3 ◽

Double Blind ◽

Safety And Efficacy ◽

Double Blind Placebo ◽

Degenerative Cervical Myelopathy

Fehlings MG, Badhiwala JH, Ahn H, et al. Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol. 2020.

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