scholarly journals Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

2020 ◽  
Vol 9 (3) ◽  
pp. 759 ◽  
Author(s):  
Rocco Severino ◽  
Aria Nouri ◽  
Enrico Tessitore
Keyword(s):  
Cervical Myelopathy ◽  
Diffusion Tensor ◽  
Inverse Correlation ◽  
Postoperative Outcome ◽  
Definitive Treatment ◽  
Conduction Time ◽  
Japanese Orthopedic Association ◽  
Conventional Mri ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

scholarly journals First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

2021 ◽  
Author(s):  
Neriman Özkan ◽  
Mehdi Chihi ◽  
Tobias Schoemberg ◽  
Thiemo Florin Dinger ◽  
Moritz Helsper ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Neurological Outcome ◽  
Postoperative Outcome ◽  
Gait Disturbance ◽  
Motor Deficits ◽  
Japanese Orthopedic Association ◽  
Spinal Cord Dysfunction ◽  
Degenerative Cervical Myelopathy ◽  
Gait Disturbances ◽  
The Relationship

Abstract Purpose Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. Methods A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. Results In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. Conclusion Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.

scholarly journals Is microdiffusion imaging able to improve the detection of cervical myelopathy? Study protocol of a prospective observational trial (MIDICAM-Trial)

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029153
Author(s):  
Marc Hohenhaus ◽  
Karl Egger ◽  
Jan-Helge Klingler ◽  
Ulrich Hubbe ◽  
Marco Reisert ◽  
...  
Keyword(s):  
Study Protocol ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Negative Control ◽  
Observational Trial ◽  
Conventional Mri ◽  
Diffusion Parameters ◽  
Registration Number ◽  
Degenerative Cervical Myelopathy ◽  
Tissue Alterations

IntroductionThe diagnosis of degenerative cervical myelopathy (DCM) is difficult in numerous patients due to the limited correlation of clinical symptoms, electrophysiology and MRI. This applies especially for early disease stages with mild symptoms or in uncertainty due to comorbidities. Conventional MRI myelopathy signs show a restricted sensitivity to clinical symptoms of at most 60%. It is desirable to select patients for surgical treatment as early as possible before irreversible neurological damage occurs. To improve treatment, a more reliable imaging is necessary. Microdiffusion imaging (MIDI) is an innovative MRI modality to depict tissue alterations within one voxel based on diffusion-weighted imaging (DWI) postprocessing. By separating the affected area into several mesoscopic compartments, pathological changes might be detected more sensitive through this subtle tissue resolution. We hypothesise, that MIDI shows myelopathic alterations more sensitive than conventional MRI and improves the correlation to functional impairment.Methods and analysisIn this prospective, observational trial, 130 patients with a relevant degenerative cervical spinal stenosis receive MRI including MIDI and a standard clinical and electrophysiological assessment. Special subvoxel diffusion parameters are calculated. Clinical follow-ups are conducted after 3, 6 and with additional MRI and electrophysiology after 12 months. The primary endpoint is the sensitivity of MIDI to detect functional myelopathy defined by clinical and electrophysiological features correlated to conventional MRI myelopathy signs. Twenty healthy subjects will be included as negative control. The results will provide new insights into the development of mesoscopic spinal cord alterations in DCM associated to the clinical course. Aim is to improve the diagnostics of incipient myelopathy through this new modality.Ethics and disseminationThe study protocol is approved by the Ethics Committee of the University of Freiburg (reference 261/17). The results will be published in a peer-reviewed journal.Trial registration numberDRKS00012962.

177 The Relationship Between MRI Signal Intensity Changes, Clinical Presentation, and Surgical Outcome in Degenerative Cervical Myelopathy: Analysis of a Global Cohort

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 246-246
Author(s):  
Aria Nouri ◽  
Allan R Martin ◽  
So Kato ◽  
Hamed Reihani-Kermani ◽  
Lauren Riehm ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Surgical Outcome ◽  
Neurological Recovery ◽  
Recovery Ratio ◽  
Baseline Severity ◽  
Signal Change ◽  
Signal Changes ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy ◽  
The Relationship

Abstract INTRODUCTION Several reports have investigated the relationship between MRI signal changes and the extent of spinal cord dysfunction and potential for postoperative neurological recovery in patients with Degenerative Cervical Myelopathy (DCM). However, there remains ambiguity if these signal changes relate with baseline severity, and predict neurological recovery after surgical treatment. The present study aims to address this knowledge gap by investigating a large global cohort of DCM patients. METHODS 419 MRIs from two prospective multicenter studies were examined. Images were assessed for the presence, levels, and location of cord signal changes and compared with clinical data (signs/symptoms, mJOA, Nurick). Inter-rater reliability for signal changes was calculated. Signal changes were also evaluated for prediction of 2-year post-operative outcome using 2 approaches: (1) Hirabayashi recovery ratio, (2) a dichotomized mJOA score of <16 and = 16 at 2-years representing a suboptimal and optimal neurological outcome, respectively. RESULTS >MRIs were categorized by signal change: no signal change (28.9%), T2 hyperintensity-only (T2-only, 51.8%), and T2-hyperintensity and T1-hypointensity (T1+T2, 19.3%). T2-hyperintensity was present at multiple levels in 27% of patients overall. There was moderate/substantial agreement (Kappa: 0.60) for T2-hyperintensity, and fair agreement for T1-hypointensity (Kappa: 0.31) identification among 3 raters. Baseline severity increased from no signal change to T2-only to T2+T1 (P < 0.0001), and there was an incremental increase in the frequency of signs/symptoms. The presence of T1-hypointensity correlated with reduced recovery ratio (P = 0.03) and likelihood of an optimal surgical outcome (P = 0.005). Greater number of T2-hyperintensity levels was also associated with worse baseline severity (P < 0.0001) and recovery ratio (P = 0.001). CONCLUSION This is the largest study of DCM patients to show an increasing stepwise impairment from no signal change to T2-hypertensity to T1-hypointensity. While T2-hyperintensity alone does not predict outcomes, T1-hypointensity indicates more permanent injury, portending decreased functional recovery. Multilevel T2-hyperintensity suggests additional tissue injury, correlating with worse impairment and recovery potential.

scholarly journals P.222 Subjective pattern of postoperative neurological recovery in degenerative cervical myelopathy varies by preoperative severity of disease

2021 ◽  
Vol 48 (s3) ◽  
pp. S84-S84
Author(s):  
AC Friesen ◽  
SA Detombe ◽  
P Doyle-Pettypiece ◽  
W Ng ◽  
K Gurr ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Cord Compression ◽  
Patient Expectations ◽  
Postoperative Recovery ◽  
Neurological Deficits ◽  
Postoperative Patient ◽  
Japanese Orthopedic Association ◽  
Sphincter Function ◽  
Moderate Disease ◽  
Degenerative Cervical Myelopathy

Background: Degenerative cervical myelopathy is a spinal disorder resulting in progressive spinal cord compression and consequent neurological deficits that can be assessed and tracked using the modified Japanese Orthopedic Association (mJOA) questionnaire. However, it is difficult to predict which patients will recover neurological function after surgery, making it difficult for clinicians to set reliable postoperative patient expectations. Methods: Sixty-eight operative myelopathy patients (50 male, 14 female) consented to complete the mJOA questionnaire both preoperatively and 6-months postoperatively. Fifteen of these patients had mild, twenty-three had moderate, and thirty had severe preoperative disease. Results: We found that in mild myelopathy, sensation and strength recover in similar proportions. In moderate myelopathy, a greater proportion of patients recover in each domain except for sensation. Recovery in severe myelopathy was comparable to moderate disease, but showed more dramatic recovery in sensation and sphincter function. Conclusions: This study shows that the severity of myelopathic disease influences the pattern of postoperative recovery. Though limited in sample size, the recovery patterns identified above are an important first step in recognizing myelopathy as a disease that patients experience heterogeneously both pre- and post-operatively. Our results will aid clinicians in goals-of-surgery discussions and assist with managing postoperative patient expectations.

scholarly journals P.172 Diffusion MRI characteristics change in select cerebral white matter tracts after decompressive surgery for degenerative cervical myelopathy

2021 ◽  
Vol 48 (s3) ◽  
pp. S69-S69
Author(s):  
AC Friesen ◽  
SA Detombe ◽  
P Doyle-Pettypiece ◽  
H Haddad ◽  
W Ng ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
White Matter ◽  
Corpus Callosum ◽  
Cervical Myelopathy ◽  
Corticospinal Tract ◽  
Diffusion Tensor ◽  
Recovery Period ◽  
White Matter Tracts ◽  
Corticospinal Tracts ◽  
Degenerative Cervical Myelopathy

Background: Degenerative cervical myelopathy is characterized by progressive compression of the spinal cord resulting in debilitating loss of dexterity, independent ambulation, and sphincter control. Diffusion tensor imaging (DTI) has shown that, compared to healthy controls, myelopathy patients have decreased integrity of the corticospinal tracts and corpus callosum (Bernabeu-Sanz et al, 2020). Methods: Twenty-six myelopathy patients consented to cerebral diffusion tensor imaging (3 Tesla, 32 directions, b=1000) preoperatively, as well as 6-weeks, 12-weeks, and 6-months postoperatively. Average mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity (AD) were measured in the corticospinal tracts, forceps major, and forceps minor. Results: Both MD and RD decreased from 6-12 weeks postoperatively in the right corticospinal tract. The forceps major of the corpus callosum showed an initial postoperative increase in MD followed by a subsequent increase in FA and decrease in RD 3-6 months postoperatively. The AD of the forceps major increased both immediately and 3-6 months postoperatively. Conclusions: Changes in microstructural integrity of the corticospinal tract and forceps major over the postoperative recovery period suggest a pattern of recovery in myelopathy patients. This study is the first to report postoperative DTI changes in myelopathy-relevant white matter tracts in the brain.

scholarly journals Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

2020 ◽  
Author(s):  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
Toshitaka Yoshii ◽  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Neck Disability Index ◽  
Multiple Linear Regression Model ◽  
Vertical Axis ◽  
Neurological Recovery ◽  
Anterior Decompression ◽  
Sagittal Vertical Axis ◽  
Japanese Orthopedic Association ◽  
Degenerative Cervical Myelopathy

Abstract Background Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. However, it is difficult to preoperatively predict the extent to which patients will experience postoperative neurological improvement. We aimed to identify predictors associated with neurological recovery after ADF in a retrospective study of prospectively collected data. Methods We prospectively enrolled patients who were scheduled for ADF for DCM. The associations of baseline variables with recovery rate were investigated using a multiple linear regression model. Results In total, 36 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life Five Dimensions Scale, Neck Disability Index, and Physical Component Summary of the SF-36 (PCS) scores improved postoperatively. The recovery rate was significantly correlated with the sagittal vertical axis (SVA) and T1 pelvic angle. Univariate regression analyses showed that the SVA and PCS score were significantly associated with recovery rate. Lastly, multiple regression analysis identified the independent predictors of recovery rate after ADF as thoracic kyphosis (TK), PCS, and SVA. According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS). Conclusion Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, DCM patients with these predictors who undergo ADF might be cautioned about poor recovery and be required to provide adequate informed consent.

scholarly journals The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy

2020 ◽  
Vol 9 (6) ◽  
pp. 1828 ◽  
Author(s):  
Stefania d’Avanzo ◽  
Marco Ciavarro ◽  
Luigi Pavone ◽  
Gabriele Pasqua ◽  
Francesco Ricciardi ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Cervical Myelopathy ◽  
Diffusion Tensor ◽  
Diagnostic Value ◽  
Hand Strength ◽  
Predictive Tool ◽  
Left Hand ◽  
Before And After ◽  
The Right ◽  
Degenerative Cervical Myelopathy

(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R2 = 0.0735, p = 0.19 for the right hand; r = 0.2087, R2 = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity.

scholarly journals Quantitative Assessment of Gait Characteristics in Degenerative Cervical Myelopathy: A Prospective Clinical Study

2020 ◽  
Vol 9 (3) ◽  
pp. 752 ◽  
Author(s):  
Sukhvinder Kalsi-Ryan ◽  
Anna C. Rienmueller ◽  
Lauren Riehm ◽  
Colin Chan ◽  
Daniel Jin ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Rank Correlation ◽  
Neurological Status ◽  
Therapeutic Interventions ◽  
Prospective Clinical Study ◽  
Early Presentation ◽  
Japanese Orthopedic Association ◽  
Gait Parameters ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

It is challenging to discriminate the early presentation of Degenerative Cervical Myelopathy (DCM) as well as sensitively and accurately distinguishing between mild, moderate, and severe levels of impairment. As gait dysfunction is one of the cardinal symptoms of DCM, we hypothesized that spatiotemporal gait parameters, including the enhanced gait variability index (eGVI), could be used to sensitively discriminate between different severities of DCM. A total of 153 patients recently diagnosed with DCM were recruited and stratified on the basis of DCM severity grades, as measured using the modified Japanese Orthopedic Association (mJOA) scale. Demographic information and neurological status were collected. Gait assessments were performed using an 8 m walkway. Spearman rank correlation was used to identify relationships between gait parameters and mJOA values as well as the mJOA lower extremity (LE) subscore. Kruskal–Wallis H test was performed to evaluate differences between severity groups, as defined by mJOA classification. A significant and relatively strong correlation was found between the mJOA score and eGVI, as well as between the LE subscore of the mJOA and eGVI. Significant differences in the eGVI (X2(2, N = 153) = 55.04, p < 0.0001, ε2 = 0.36) were found between all groups of DCM severity, with a significant increase in the eGVI as DCM progressed from mild to moderate. The eGVI was the most discriminative gait parameter, which facilitated objective differentiation between varying severities of DCM. Quantitative gait assessments show promise as an accurate and objective tool to diagnose and classify DCM, as well as to potentially evaluate the impact of therapeutic interventions.

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