scholarly journals Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

2021 ◽  
Vol 64 (5) ◽  
pp. 808-817
Author(s):  
Hyung Cheol Kim ◽  
Hyeongseok Jeon ◽  
Yeong Ha Jeong ◽  
Sangman Park ◽  
Seong Bae An ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Hand Function ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Adjacent Segment ◽  
Factors Affecting ◽  
Cervical Surgery

Objective : Cervical surgery in patients with cervical spondylotic myelopathy (CSM) and cerebral palsy (CP) is challenging owing to the complexities of the deformity. We assessed factors affecting postoperative complications and outcomes after CSM surgery in patients with CP.Methods : Thirty-five consecutive patients with CP and CSM who underwent cervical operations between January 2006 and January 2014 were matched to 35 non-cerebral palsy (NCP) control patients. Postoperative complications and radiologic outcomes were compared between the groups. In the CP group, the Japanese Orthopaedic Association score; Oswestry neck disability index; modified Barthel index; and values for the grip and pinch, Box and Block, and Jebsen-Taylor hand function tests were obtained preand postoperatively and compared between those with and without postoperative complications.Results : Sixteen patients (16/35%) in the CP group and seven (7/35%) in the NCP group (p=0.021) had postoperative complications. Adjacent segment degeneration (p=0.021), postoperative motor weakness (p=0.037), and revisions (p=0.003) were significantly more frequent in the CP group than in the NCP group; however, instrument-related complications were not significantly higher in the CP group (7/35 vs. 5/35, p=0.280). The number of preoperative fixed cervical deformities were significantly higher in CP with postoperative complications (5/16 vs. 1/19, p=0.037). In the CP group, clinical outcomes were almost similar between those with and without postoperative complications.Conclusion : The occurrence of complications during the follow-up period was high in patients with CP. However, postoperative complications did not significantly affect clinical outcomes.

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.

scholarly journals Can segmental mobility be increased by cervical arthroplasty?

2017 ◽  
Vol 42 (2) ◽  
pp. E3 ◽  
Author(s):  
Hsuan-Kan Chang ◽  
Chih-Chang Chang ◽  
Tsung-Hsi Tu ◽  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Range Of Motion ◽  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Disc ◽  
Segmental Mobility ◽  
Arm Pain ◽  
The Mean ◽  
The Difference

OBJECTIVE Many reports have successfully demonstrated that cervical disc arthroplasty (CDA) can preserve range of motion after 1- or 2-level discectomy. However, few studies have addressed the extent of changes in segmental mobility after CDA or their clinical correlations. METHODS Data from consecutive patients who underwent 1-level CDA were retrospectively reviewed. Indications for surgery were medically intractable degenerative disc disease and spondylosis. Clinical outcomes, including visual analog scale (VAS)–measured neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores, were analyzed. Radiographic outcomes, including C2–7 Cobb angle, the difference between pre- and postoperative C2–7 Cobb angle (ΔC2–7 Cobb angle), sagittal vertical axis (SVA), the difference between pre- and postoperative SVA (ΔSVA), segmental range of motion (ROM), and the difference between pre- and postoperative ROM (ΔROM), were assessed for their association with clinical outcomes. All patients underwent CT scanning, by which the presence and severity of heterotopic ossification (HO) were determined during the follow-up. RESULTS A total of 50 patients (mean age 45.6 ± 9.33 years) underwent a 1-level CDA (Prestige LP disc) and were followed up for a mean duration of 27.7 ± 8.76 months. All clinical outcomes, including VAS, NDI, and JOA scores, improved significantly after surgery. Preoperative and postoperative ROM values were similar (mean 9.5° vs 9.0°, p > 0.05) at each indexed level. The mean changes in segmental mobility (ΔROM) were −0.5° ± 6.13°. Patients with increased segmental mobility after surgery (ΔROM > 0°) had a lower incidence of HO and HO that was less severe (p = 0.048) than those whose ΔROM was < 0°. Segmental mobility (ROM) was significantly lower in patients with higher HO grade (p = 0.012), but it did not affect the clinical outcomes. The preoperative and postoperative C2–7 Cobb angles and SVA remained similar. The postoperative C2–7 Cobb angles, SVA, ΔC2–7 Cobb angles, and ΔSVA were not correlated to clinical outcomes after CDA. CONCLUSIONS Segmental mobility (as reflected by the mean ROM) and overall cervical alignment (i.e., mean SVA and C2–7 Cobb angle) had no significant impact on clinical outcomes after 1-level CDA. Patients with increased segmental mobility (ΔROM > 0°) had significantly less HO and similarly improved clinical outcomes than those with decreased segmental mobility (ΔROM < 0°).

Cervical disc arthroplasty for less-mobile discs

2019 ◽  
Vol 31 (3) ◽  
pp. 310-316 ◽  
Author(s):  
Tsung-Hsi Tu ◽  
Chu-Yi Lee ◽  
Chao-Hung Kuo ◽  
Jau-Ching Wu ◽  
Hsuan-Kan Chang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Cervical Radiculopathy ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Segmental Mobility ◽  
Disc Arthroplasty ◽  
Flexion Extension ◽  
Index Level

OBJECTIVEThe published clinical trials of cervical disc arthroplasty (CDA) have unanimously demonstrated the success of preservation of motion (average 7°–9°) at the index level for up to 10 years postoperatively. The inclusion criteria in these trials usually required patients to have evident mobility at the level to be treated (≥ 2° on lateral flexion-extension radiographs) prior to the surgery. Although the mean range of motion (ROM) remained similar after CDA, it was unclear in these trials if patients with less preoperative ROM would have different outcomes than patients with more ROM.METHODSA series of consecutive patients who underwent CDA at the level of C5–6 were followed up and retrospectively reviewed. The indications for surgery were medically refractory cervical radiculopathy, myelopathy, or both, caused by cervical disc herniation or spondylosis. All patients were assigned to 1 of 2 groups: a less-mobile group, which consisted of those patients who had an ROM of ≤ 5° at C5–6 preoperatively, or a more-mobile group, which consisted of patients whose ROM at C5–6 was > 5° preoperatively. Clinical outcomes, including visual analog scale, Neck Disability Index, and Japanese Orthopaedic Association Scale scores, were evaluated at each time point. Radiological outcomes were also assessed.RESULTSA total of 60 patients who had follow-up for more than 2 years were analyzed. There were 27 patients in the less-mobile group (mean preoperative ROM 3.0°) and 33 in the more-mobile group (mean ROM 11.7°). The 2 groups were similar in demographics, including age, sex, diabetes, and cigarette smoking. Both groups had significant improvements in clinical outcomes, with no significant differences between the 2 groups. However, the radiological evaluations demonstrated remarkable differences. The less-mobile group had a greater increase in ΔROM than the more-mobile group (ΔROM 5.5° vs 0.1°, p = 0.001), though the less-mobile group still had less segmental mobility (ROM 8.5° vs 11.7°, p = 0.04). The rates of complications were similar in both groups.CONCLUSIONSPreoperative segmental mobility did not alter the clinical outcomes of CDA. The preoperatively less-mobile (ROM ≤ 5°) discs had similar clinical improvements and greater increase of segmental mobility (ΔROM), but remained less mobile, than the preoperatively more-mobile (ROM > 5°) discs at 2 years postoperatively.

Multi-shot echo-planar diffusion tensor imaging in cervical spondylotic myelopathy

2020 ◽  
Vol 102-B (9) ◽  
pp. 1210-1218
Author(s):  
Hanwen Zhang ◽  
Li Guan ◽  
Yong Hai ◽  
Yuzeng Liu ◽  
Hongtao Ding ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Clinical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Diffusion Tensor ◽  
Neck Disability Index ◽  
Cord Compression ◽  
Functional Improvement ◽  
High Signal ◽  
Japanese Orthopedic Association ◽  
Neck Disability

Aims The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). Methods We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. Results Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. Conclusion ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210–1218.

Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes

2014 ◽  
Vol 21 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Shinya Okuda ◽  
Takenori Oda ◽  
Ryoji Yamasaki ◽  
Takamitsu Haku ◽  
Takafumi Maeno ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Surgical Outcomes ◽  
Recovery Rate ◽  
Interbody Fusion ◽  
Japanese Orthopaedic Association ◽  
Posterior Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Isthmic Spondylolisthesis ◽  
Instrumentation Failure

Object The management of isthmic spondylolisthesis remains controversial, especially with respect to reduction. There have been no reports regarding appropriate slip reduction. The purpose of this study was to investigate the following issues: 1) surgical outcomes of posterior lumbar interbody fusion (PLIF) with total facetectomy for low-dysplastic isthmic spondylolisthesis, including postoperative complications; 2) effects of slip reduction on surgical outcomes; and 3) appropriate slip reduction. Methods A total of 106 patients who underwent PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis and who were followed for at least 2 years were reviewed. The average follow-up period was 8 years. Surgical outcomes, including the scores assessed using the Japanese Orthopaedic Association scoring system, the recovery rate, and postoperative complications were investigated. As for radiographic evaluations, pre- and postoperative slip and disc height, instrumentation failure, and fusion status were also examined. Results The pre- and postoperative average Japanese Orthopaedic Association scores were 14 (range 3–25) and 25 (range 11–29) points, respectively. The average recovery rate was 73% (range 0%–100%). The average pre- and postoperative slip was 24% and 10%, respectively. A significant correlation between postoperative slip and clinical outcomes was found; clinical outcomes were better in proportion to slip reduction. Although no statistical difference was detected in clinical outcomes between postoperative slip of less than 10% and from 10% to 20%, patients with postoperative slip of more than 20% showed significantly worse clinical outcomes. Postoperative complications included neurological deficits in 7 patients (transient motor loss in 6 and permanent motor loss in 1), instrumentation failures in 7, adjacent-segment degeneration in 5, and nonunion in 4. Instrumentation failures occurred significantly more often in patients with more slip reduction, although slip reduction did not affect the other postoperative complications. All patients with instrumentation failure showed postoperative slip reduction within 10%. Conclusions The use of PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis appears to produce satisfactory clinical outcomes, with an average of 73% recovery rate and few postoperative complications. Although clinical outcomes were better in proportion to slip reduction, excessive reduction caused instrumentation failure, and patients with less reduction demonstrated worse clinical outcomes. Appropriate reduction resulted in a postoperative slip ranging from 10% to 20%.

scholarly journals Comparative Five-Year Surgical Outcomes of Open-Door versus French-Door Laminoplasty in Multilevel Cervical Spondylotic Myelopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Guoliang Chen ◽  
Xizhe Liu ◽  
Ensi Zhao ◽  
Ningning Chen ◽  
Fuxin Wei ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Cobb Angle ◽  
Surgical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Loss Rate ◽  
Japanese Orthopaedic Association ◽  
Medical Costs ◽  
Open Door ◽  
Multilevel Cervical Spondylotic Myelopathy

Objective. To compare the five-year surgical outcomes between Open-Door laminoplasty (ODL) and French-Door laminoplasty (FDL) in the management of multilevel cervical spondylotic myelopathy (MCSM). Methods. Sixty patients with MCSM, who were operated by ODL or FDL, were included in this study and followed up for at least 5 years. The average follow-up period was 69.2 ± 3.2 months. The modified Japanese Orthopaedic Association (mJOA) score and radiological assessments including the Cobb angle and cervical range of motion (ROM) were evaluated and compared before surgery and at the final follow-up. The incidence of postoperative complications and medical costs were also compared. Results. Both ODL and FDL groups achieved significant improvements of the mJOA score in postoperative 5 years; the average recovery rate (RR) of the mJOA score in the ODL and FDL groups was 72.14 ± 6.97 % and 69.53 ± 7.51 % , respectively. No statistically significant differences regarding the pre- and postoperative mJOA score, the RR of the mJOA score, the loss and the loss rate of the Cobb angle, and the incidence of postoperative complications existed between ODL and FDL. The mean loss and the loss rate of cervical ROM in the FDL group ( 18.70 ± 8.91 ° , 41.08 ± 11.17 % ) were significantly higher than those of the ODL group ( 13.81 ± 8.62 ° , 31.47 ± 12.43 % ) ( P < 0.05 ). FDL reduced medical costs more greatly than ODL ( 33014.37 ± 3424.12 China Yuan versus 82096.62 ± 7093.07 China Yuan, P < 0.001 ). Conclusions. Both ODL and FDL are effective for MCSM. The 5-year neurological results are similar between the two groups. ODL trends to be superior to FDL in postoperative preservation of cervical ROM while FDL reduced medical costs more greatly.

Use of zero-profile device for contiguous three-level anterior cervical discectomy and fusion: comparison with cage and plate construct

2021 ◽  
pp. 1-8
Author(s):  
Zhipeng Chen ◽  
Shuizhong Cen ◽  
Jionglin Wu ◽  
Rui Guo ◽  
Zhenhua Liu ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Sagittal Alignment ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Patient Choice ◽  
Adjacent Segment ◽  
Radiographic Findings ◽  
Significant Difference ◽  
Patient Reported

OBJECTIVE The aim of this study was to compare a traditional cervical cage with a zero-profile (ZP) fixation device in patients who underwent three-level anterior cervical decompression and fusion (ACDF) in terms of patient-reported outcomes (visual analog scale [VAS], Japanese Orthopaedic Association [JOA], and Neck Disability Index [NDI] scores), radiographic findings (sagittal alignment 2 years after surgery and likelihood of fusion), and complications. METHODS This study was a retrospective case series. Between January 2012 and December 2016, 58 patients with cervical spondylotic myelopathy (CSM) who required three-level ACDF procedures, as identified by spinal surgeons, were treated with three-level ACDF and an anterior cage-plate construct (ACPC) (n = 38) or a three-level stand-alone ZP device (n = 20). On the basis of patient choice, patients were divided into two groups (ACPC group and ZP group). All patients completed a minimum of 2 years of follow-up. Patient-reported outcome scores included VAS, JOA, and NDI scores. The radiographic findings included sagittal alignment and likelihood of fusion 2 years after surgery. Data related to patient-reported outcomes and sagittal alignment were collected preoperatively, postoperatively, and at the final follow-up. Intraoperative and postoperative complications were also documented and analyzed. RESULTS The clinical outcomes, including VAS, JOA, and NDI scores, showed improvement in both groups, and no significant difference was observed between the two groups. Sagittal alignment and height of the fused segments were restored in all patients. However, the authors found no differences between the ZP and ACPC groups, and the groups exhibited similar fusion rates. The authors found no differences in complications, including dysphagia, adjacent-segment degeneration, and postoperative hematoma, between the groups. CONCLUSIONS Use of ZP implants yielded satisfactory long-term clinical and radiological outcomes that were similar to those of the standard ACPC. Additionally, the rates of complications between the groups were not significantly different. Although the best surgical option for multilevel CSM remains controversial, the results of this work suggest that ACDF with the ZP device is feasible, safe, and effective, even for multilevel CSM.

Comparison of anterior- and posterior-approach instrumented lumbar interbody fusion for spondylolisthesis

2007 ◽  
Vol 7 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Jun-Hong Min ◽  
Jee-Soo Jang ◽  
Sang-Ho Lee
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Lordosis ◽  
Interbody Fusion ◽  
Clinical Success ◽  
Japanese Orthopaedic Association ◽  
Reduction Rate ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Lumbar Interbody Fusion ◽  
Lumbar Spondylolisthesis

Object The purpose of this study was to compare the imaging and clinical outcomes obtained in patients with lumbar spondylolisthesis who have undergone either instrumented anterior lumbar interbody fusion (ALIF) or instrumented posterior LIF (PLIF), especially with regard to the development of adjacent-segment degeneration (ASD). Methods Forty-eight patients with preoperative spondylolisthesis and minimal ASD who underwent instrumented L4–5 fusion were divided into two groups according to the surgical approach. After ensuring the two groups' comparability, the following variables were evaluated: postoperative segmental and lumbar lordosis, postoperative percentage of vertebral slippage, reduction rate, incidence of ASD, and clinical outcomes. Results Adjacent-segment degeneration was found in 44.0% of the patients in the ALIF group and in 82.6% of those in the PLIF group (p = 0.008). Clinical success rates were 92.0 and 87.0% in the ALIF and PLIF groups, respectively. There were no statistically significant intergroup differences in the postoperative segmental and lumbar lordosis, postoperative percentage of slippage, reduction rate, Japanese Orthopaedic Association score, and success rate. Conclusions Both ALIF and PLIF can produce good outcomes in treating lumbar spondylolisthesis, but ALIF is more advantageous in preventing the development of ASD.

356 Quantitative Magnetization Transfer MRI Measurements of the Anterior Spinal Cord Region are Associated with Clinical Outcomes in Cervical Spondylotic Myelopathy

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 281-282
Author(s):  
Michael Brendan Cloney ◽  
Andy C Smith ◽  
Kenneth Weber ◽  
Meijing Wu ◽  
Taylor Coffey ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Magnetization Transfer ◽  
Neck Disability Index ◽  
Quantitative Measure ◽  
Magnetization Transfer Ratio ◽  
Mri Imaging ◽  
Tissue Destruction ◽  
Japanese Orthopedic Association ◽  
Lateral Cord

Abstract INTRODUCTION Magnetization transfer ratio (MTR) is a quantitative measure that correlates with myelin loss and neural tissue destruction in a variety of neurological diseases. For example, in patients with multiple sclerosis, MTR of white matter lesions may predict clinical disability. However, the usefulness of MTR in patients with cervical spondylotic myelopathy (CSM) has not been examined. METHODS We prospectively enrolled seven CSM patients and seven age-matched controls to undergo MRI imaging of the cervical spine. Nurick, Neck Disability Index (NDI), and modified Japanese Orthopedic Association (mJOA) scores were collected for all patients. Clinical hyperreflexia was tested at the MCP joint, using a 6-axis load cell. Reflex was simulated by quickly moving the joint from maximum flexion to maximum extension (300 °/sec). Anterior, lateral, and posterior cord MTR measurements were compared to clinical outcomes. RESULTS >Compared to controls, CSM patients had lower anterior cord MTR (38.29 v. 29.97, ? = −8.314, P = 0.0022), and equivalent posterior cord (P = 0.2896) and lateral cord (P = 0.3062) MTR. Higher Nurick scores were associated with lower anterior cord MTR (P = 0.0205), but not lateral cord (P = 0.5446) or posterior cord MTR (P = 0.1222). Lower mJOA was associated with lower anterior cord MTR (P = 0.0090), but not lateral cord (P = 0.4864) or posterior cord MTR (P = 0.4819). There was no association between NDI and MTR of the anterior (P = 0.4351), lateral (P = 0.7557), or posterior cord (P = 0.9171). There was a linear relationship between hyperreflexia and anterior cord MTR (slope = −117.3, R = 0.6598, P = 0.0379), but not lateral cord (P = 0.1906, R = 0.4511) or posterior cord (P = 0.2577, R = 0.3957) MTR. CONCLUSION Anterior cord MTR correlates with clinical outcomes as measured by mJOA index, Nurick score, and quantitative hyperreflexia. Anterior cord MTR is associated with clinically relevant hyperreflexia, and could play a role in the preoperative assessment of CSM. Understanding this radiological metric may refine surgical decision-making.

scholarly journals N-acetylaspartate in the motor and sensory cortices following functional recovery after surgery for cervical spondylotic myelopathy

2016 ◽  
Vol 25 (4) ◽  
pp. 436-443 ◽  
Author(s):  
Sandy Goncalves ◽  
Todd K. Stevens ◽  
Patricia Doyle-Pettypiece ◽  
Robert Bartha ◽  
Neil Duggal
Keyword(s):  
Spinal Cord ◽  
Cervical Spondylotic Myelopathy ◽  
Time Course ◽  
Spinal Injury ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Neurological Recovery ◽  
Decompression Surgery ◽  
Control Subjects ◽  
Sensory Cortices

OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of reversible spinal cord dysfunction in people over the age of 55 years. Following surgery for symptomatic CSM, patients demonstrate motor improvement early in the postoperative course, whereas sensory improvement can lag behind. The authors of the present study hypothesized that changes in the concentration of N-acetylaspartate (NAA) in the motor and sensory cortices in the brain would emulate the time course of neurological recovery following decompression surgery for CSM. Their aim was to compare and contrast how metabolite levels in the motor and sensory cortices change after surgery to reverse downstream spinal cord compression. METHODS Twenty-four patients with CSM and 8 control subjects were studied using proton MR spectroscopy (1H-MRS) images acquired on a 3.0-T Siemens MRI unit. The 1H-MRS data (TE 135 msec, TR 2000 msec) were acquired to measure absolute levels of NAA from the motor and sensory cortices in the cerebral hemisphere contralateral to the side of greater deficit at baseline in each subject. Data were also acquired at 6 weeks and 6 months following surgery. Control subjects were also evaluated at 6 weeks and 6 months following baseline data acquisition. Neurological function was measured in each subject at all time points using the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) questionnaire, and the American Spinal Injury Association (ASIA) neurological classification. RESULTS In the motor cortex of patients, NAA levels decreased significantly (p < 0.05) at 6 weeks and 6 months postsurgery compared with baseline levels. In the sensory cortex of patients, NAA levels decreased significantly (p < 0.05) only at 6 months after surgery compared with baseline and 6-week levels. No significant changes in NAA were found in control subjects. Clinical scores demonstrated significant (p < 0.05) motor recovery by 6 weeks, whereas sensory improvements (p < 0.05) appeared at only 6 months. CONCLUSIONS Findings suggest that metabolite changes in both the motor and sensory cortices mimic the time course of functional motor and sensory recovery in patients with CSM. The temporal course of neurological recovery may be influenced by metabolic changes in respective cortical regions.

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