Myofacial Release for the Management of Cervical Compressive Myelopathy – Case Study

Cervical compressive myelopathy commonly occurs due to degeneration or disc herniation. The persons with cervical meylopathy are usually advised for surgical decompression. Person with signs of cervical cord compression was treated with myofacial release and found to be improved in signs as well as the symptoms. Total 34 numbers of similar cases (31 males and 3 females) age ranging from 25 to 61 years were treated by myofascial release of periscapular soft tissue structures over last 2 & ½ years (2017 to 2020) and found to return back to their activities after 6 months of follow up.

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Clinical and radiographic outcome of unilateral open-door laminoplasty with alternative levels centerpiece mini-plate fixation for cervical compressive myelopathy: a five-year follow-up study

International Orthopaedics ◽

10.1007/s00264-016-3194-3 ◽

2016 ◽

Vol 40 (6) ◽

pp. 1267-1274 ◽

Cited By ~ 12

Author(s):

Lin-nan Wang ◽

Lei Wang ◽

Yue-ming Song ◽

Xi Yang ◽

Li-min Liu ◽

...

Keyword(s):

Plate Fixation ◽

Open Door ◽

Radiographic Outcome ◽

Follow Up Study ◽

Cervical Compressive Myelopathy ◽

Compressive Myelopathy ◽

Mini Plate

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Evaluation of clinical profile, radiological and functional outcome following anterior cervical discectomy and fusion for cervical compressive myelopathy

International Surgery Journal ◽

10.18203/2349-2902.isj20203069 ◽

2020 ◽

Vol 7 (8) ◽

pp. 2679

Author(s):

Ranjit Kumar ◽

Brijesh Kumar Tiwari ◽

Sanjeev Kumar Pandey

Keyword(s):

Cervical Spine ◽

Blood Loss ◽

Surgical Outcome ◽

Postoperative Outcome ◽

Anterior Cervical Discectomy ◽

Cervical Disc ◽

Cervical Cord ◽

Cervical Discectomy ◽

Cervical Compressive Myelopathy ◽

Compressive Myelopathy

Background: Symptomatic cervical disc prolapse is best managed with anterior cervical discectomy with or without fusion. We studied the clinical, radiological and surgical profile with postoperative outcome of the patients undergoing anterior cervical discectomy and fusion (ACDF) for cervical compressive myelopathy at one level.Methods: In this retrospective study, data was collected from patients who underwent ACDF for cervical compressive myelopathy in our hospital between 2016 and 2019. Clinical, radiological profile with surgical outcome were studied.Results: A total of 283 patients were recruited. They could be followed up for a period of at least 6 months and so were recruited for the study. Out of these 283 patients (201 males; 82 females; mean age, 48.4 years, range, 22 years to 83 years), magnetic resonance imaging (MRI) cervical spine without contrast and x-ray cervical spine was available for all the patients. Nape of neck pain was the most common presenting symptom followed by tingling sensation in all four limbs and trunk. Average time taken for surgery was 2 hours 10 minutes with an average blood loss of 50 ml. Mean follow up duration was 2.7 years (range 6 months to 4 years).Conclusions: ACDF is the treatment of choice for the patients with clinical and radiological evidence of cervical cord compression. The techniques is associated with minimal blood loss and exceptionally good surgical outcome. Following discectomy, putting an autologous graft or titanium cage improves the spine stability and maintains the cervical lordosis.

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Role of Decompressive Laminectomy without Instrumentation in the Management of Nurick Grade 4 and 5 Cervical Compressive Myelopathy

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_254_18 ◽

2019 ◽

Vol 10 (01) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Sunil Malagi ◽

Subhas Konar ◽

Dhaval P. Shukla ◽

Dhananjaya I. Bhat ◽

Nishanth Sadashiva ◽

...

Keyword(s):

Posterior Longitudinal Ligament ◽

Female Ratio ◽

Decompressive Laminectomy ◽

Japanese Orthopedic Association ◽

Poor Grade ◽

Cervical Compressive Myelopathy ◽

The Mean ◽

Ossified Posterior Longitudinal Ligament ◽

Compressive Myelopathy

ABSTRACT Introduction: Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM. Methods: This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score. Results: A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months' duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome. Conclusion: Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

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Quick Reference: Chapter 3: The Peripheral Nervous System

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1999.sepoct03 ◽

1999 ◽

Vol 4 (5) ◽

pp. 5-6

Keyword(s):

Real Life ◽

Cord Compression ◽

School Principal ◽

High School Principal ◽

Cervical Cord ◽

Disc Protrusion ◽

Burning Pain ◽

Injury Model ◽

Iliac Bone Graft

Abstract Most impairment ratings for conditions affecting the cervical spine are relatively straightforward and can be addressed using the first three categories of the Injury Model in the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). This real-life case study illustrates how higher impairment categories are applied, including combining categories; the importance of rating the patient's condition based on the injury (as opposed to treatment outcome); and how apportionment is handled in different jurisdictions. Mr Smith, a 64-year-old high school principal, presented with numbness and burning pain from the chest to the feet, unsteadiness of gait, and difficulty maintaining an erection. Symptoms reportedly began two years earlier when he tripped and fell down a flight of stairs at work, striking his face. An MRI scan revealed marked spinal stenosis and cervical cord compression at C3 due to a combination of posterior C3-4 disc protrusion and osteophyte formation. Via an anterior approach, the orthopedic surgeon performed a C4 corpectomy, C3-4 and C4-5 discectomies, and then inserted a tricortical iliac bone graft between C3 and C5. Mr Smith improved postoperatively but still complained of numbness from upper chest to feet, mild unsteadiness of gait, and difficulty maintaining an erection. Evaluators can use the Injury Model, recalling that surgery to treat an impairment does not modify the original impairment, and in the jurisdiction in which Mr Smith was rated, if a claimant was asymptomatic before a work injury, the entire impairment is attributed thereto.

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Radiological manifestations and surgical outcome of combined upper cervical cord compression and cervical ossification of the posterior longitudinal ligament with a minimum 2-year follow-up

Medicine ◽

10.1097/md.0000000000008332 ◽

2017 ◽

Vol 96 (45) ◽

pp. e8332 ◽

Cited By ~ 1

Author(s):

Hao Li ◽

Xiaopeng Zhou ◽

Gang Chen ◽

Fangcai Li ◽

Junfeng Zhu ◽

...

Keyword(s):

Surgical Outcome ◽

Posterior Longitudinal Ligament ◽

Cord Compression ◽

Cervical Cord ◽

Cervical Cord Compression ◽

Upper Cervical

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THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

Coluna/Columna ◽

10.1590/s1808-185120161503157849 ◽

2016 ◽

Vol 15 (3) ◽

pp. 213-218 ◽

Cited By ~ 1

Author(s):

MURILO TAVARES DAHER ◽

PEDRO FELISBINO JUNIOR ◽

ADRIANO PASSÁGLIA ESPERIDIÃO ◽

BRENDA CRISTINA RIBEIRO ARAÚJO ◽

ANDRÉ LUIZ PASSOS CARDOSO ◽

...

Keyword(s):

Disc Herniation ◽

Posterior Approach ◽

Surgical Decompression ◽

Thoracic Disc Herniation ◽

Transpedicular Approach ◽

Partial Body ◽

The Mean ◽

Thoracic Disc ◽

A La Carte

ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte). Methods: We evaluated thirteen patients (14 hernias) treated by the posterior approach. Eight (61.5%) patients were male and the mean age was 53 years (34-81). Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months). Of the 14 operated hernias, six (43%) were lateral, 2 (14%) paramedian, and 6 (43%) central. Seven were soft (50%) and seven were calcified. The transfacet approach was carried out in 5 cases (36%), transpedicular in 1 case (7%), transpedicular + partial body resection in 4 (29%), costotransversectomy in 3 (21%), and costotransversectomy + CAGE in one case (7%). The majority of patients with lateral hernia (5/6) were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

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Quantifying the impact of surgical decompression on quality of life and identification of factors associated with outcomes in patients with symptomatic metastatic spinal cord compression

Journal of Neurosurgery Spine ◽

10.3171/2020.1.spine191326 ◽

2020 ◽

Vol 33 (2) ◽

pp. 237-244

Author(s):

Asad M. Lak ◽

Amina Rahimi ◽

Abdullah M. Abunimer ◽

Ian Tafel ◽

Sharmila Devi ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Intervention ◽

Cord Compression ◽

Surgical Decompression ◽

First Year ◽

Motor Weakness ◽

The Mean ◽

The Impact

OBJECTIVEMetastatic spinal cord compression (MSCC) imposes significant impairment on patient quality of life and often requires immediate surgical intervention. In this study the authors sought to estimate the impact of surgical intervention on patient quality of life in the form of mean quality-adjusted life years (QALY) gained and identify factors associated with positive outcomes.METHODSThe authors performed a retrospective chart review and collected data for patients who had neurological symptoms resulting from radiologically and histologically confirmed MSCC and were treated with surgical decompression during the last 12 years.RESULTSA total of 151 patients were included in this study (mean age 60.4 years, 57.6% males). The 5 most common metastatic tumor types were lung, multiple myeloma, renal, breast, and prostate cancer. The majority of patients had radioresistant tumors (82.7%) and had an active primary site at presentation (67.5%). The median time from tumor diagnosis to cord compression was 12 months and the median time from identification of cord compression to death was 4 months. Preoperative presenting symptoms included motor weakness (70.8%), pain (70.1%), sensory disturbances (47.6%), and bowel or bladder disturbance (31.1%). The median estimated blood loss was 500 mL and the average length of hospital stay was 10.3 days. About 18% of patients had postoperative complications and the mean follow-up was 7 months. The mean pre- and postoperative ECOG (Eastern Cooperative Oncology Group) performance status grades were 3.2 and 2.4, respectively. At follow-up, 58.3% of patients had improved status, 31.5% had no improvement, and 10.0% had worsening of functional status. The mean QALY gained per year in the entire cohort was 0.55. The mean QALY gained in the first 6 months was 0.1 and in the first year was 0.4. For patients who lived 1–2, 2–3, 3–4, or 4–5 years, the mean QALY gained were 0.8, 1.4, 1.7, and 2.3, respectively. Preoperative motor weakness, bowel dysfunction, bladder dysfunction, and ASA (American Society of Anesthesiologists) class were identified as independent predictors inversely associated with good outcome.CONCLUSIONSThe mean QALY gained from surgical decompression in the first 6 months and first year equals 1.2 months and 5 months of life in perfect health, respectively. These findings suggest that surgery might also be beneficial to patients with life expectancy < 6 months.

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Transthoracic Discectomy for Symptomatic Thoracic Disc Herniation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opy407 ◽

2019 ◽

Vol 17 (4) ◽

pp. E158-E158

Author(s):

Yamaan S Saadeh ◽

Siri S Khalsa ◽

Brandon W Smith ◽

Jacob R Joseph ◽

Rhami F Khorfan ◽

...

Keyword(s):

Spinal Cord ◽

Back Pain ◽

Disc Herniation ◽

Interbody Fusion ◽

Cord Compression ◽

Lower Extremity Muscle ◽

High Clinical Suspicion ◽

Disc Herniations ◽

Thoracic Disc

Abstract Thoracic disc herniations are an infrequent occurrence, but can be a cause of significant myelopathy. Diagnosis typically requires a high clinical suspicion that is confirmed with appropriate imaging. Classically, the transthoracic approach for discectomy is the treatment of choice for symptomatic cases. This video concerns a 48-yr-old woman who presented with worsening mid-back pain and progressive gait difficulty. Her examination was significant for proximal lower extremity muscle weakness, difficulty with tandem gait, and urinary incontinence. Imaging demonstrated a large T7-8 disc herniation causing severe spinal cord compression. The patient underwent T7-8 transthoracic discectomy and interbody fusion. She tolerated the procedure well without complication, and postoperative imaging demonstrated decompression of her spinal cord. On follow-up, she had improved mid-back pain, strength, and ambulatory function. The patient consented to the recording of this surgical video for potential publication.

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Trajectory of Improvement in Myelopathic Symptoms From 3 to 12 Months Following Surgery for Degenerative Cervical Myelopathy

Neurosurgery ◽

10.1093/neuros/nyz325 ◽

2019 ◽

Vol 86 (6) ◽

pp. 763-768

Author(s):

Inamullah Khan ◽

Kristin R Archer ◽

John Paul Wanner ◽

Mohamad Bydon ◽

Jacquelyn S Pennings ◽

...

Keyword(s):

Cervical Myelopathy ◽

Elective Surgery ◽

Japanese Orthopaedic Association ◽

Cord Compression ◽

Cervical Cord ◽

Multivariable Logistic Regression Model ◽

Quality Outcomes ◽

Degenerative Cervical Myelopathy ◽

Postoperative Improvement

Abstract BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The modified Japanese Orthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored. OBJECTIVE To utilize the Quality Outcomes Database (QOD) to evaluate the trajectory of outcomes in those operatively treated for DCM. METHODS This study is a retrospective analysis of prospectively collected data. The QOD was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9-13), or severe (<9) categories for their baseline severity of myelopathic symptoms (mJOA scores). A parsimonious multivariable logistic regression model was fitted with 2 points improvement on mJOA from 3- to 12-mo follow-up as the outcome of interest. RESULTS A total of 2156 patients who underwent elective surgery for DCM and had complete 3- and 12-mo follow-up were included in our analysis. Patients improved significantly from baseline to 3-mo on their mJOA scores, regardless of their baseline mJOA severity. After adjusting for the relevant preoperative characteristics, the baseline mJOA categories had significant impact on outcome of whether a patient keeps improving in mJOA score from 3 to 12 mo postsurgery. Patient with severe mJOA score at baseline had a higher likelihood of improvement in their myelopathic symptoms, compared to patients with mild mJOA score in. CONCLUSION Most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep on improving until after a longer follow-up. Preoperative identification of such patients helps the clinician settling realistic expectations for each follow-up timepoint.

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