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.

Laminoplasty versus laminectomy with fusion for treatment of multilevel cervical compressive myelopathy: an updated meta-analysis

BackgroundMultilevel cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) are debilitating degenerative diseases. If conservative treatment is ineffective, surgical options for multilevel CSM and OPLL include laminoplasty (LP) and laminectomy with fusion (LF). In this updated meta-analysis, we aimed to compare the clinical outcomes and complications of both approaches.MethodsWe searched PubMed, the Cochrane Library and Embase datasets from their inception to 31 March 2020, to identify all eligible studies comparing LP versus LF for multilevel CSM and OPLL. Data were extracted according to predefined endpoints. We summarised data by the random-effects or fixed-effect models, as necessary.ResultsOf 533 eligible studies, 16 were identified, which included 638 patients who underwent LP and 671 patients who underwent LF. No significant differences were observed between preoperative and postoperative scores of the Japanese Orthopaedic Association (p=1.0 and 0.20, respectively); Visual Analogue Scale (p=0.24 and 0.89, respectively); sagittal vertical axis ((p=0.16 and 0.87, respectively); Nurick Scale (p=0.59 and 0.17, respectively); and range of motion (p=0.67 and 0.63, respectively). However, total complications were higher for LF compared with LP (p=0.006). A significantly higher incidence of C5 palsy was observed in the LF group (p=0.004). The postoperative Neck Disability Index (NDI) was also higher in the LF group (p<0.001).ConclusionsAlthough LP and LF shared similar clinical improvement, LP had fewer complications, a lower incidence of C5 palsy, and better NDI scores and recovery outcomes than LF. Randomised studies are warranted to validate these findings.

Discrimination between spinal cord injury and cervical compressive myelopathy in intramedullary high-intensity lesions on T2-weighted magnetic resonance imaging

Background: When intramedullary high-intensity lesions are found on cervical T2-weighted magnetic resonance images of patients with whiplash injury, it is often required to identify whether they are due to spinal cord injury (SCI) or cervical compressive myelopathy (CCM). This is important to determine insurance coverage. Thus, this study aimed to develop a method to distinguish between SCI and CCM.Methods: Magnetic resonance images of 20 patients who had cervical SCI were evaluated. These 20 SCI patients were age- and sex-matched to 20 CCM patients. The number of discs adjacent to T2 high-intensity lesions was counted because the T2 high-intensity lesions in SCI were characterized by sagittal dilation. The “snake-eyes appearance” was assessed as a characteristic finding of CCM. T2 values in T2 high-intensity lesions were evaluated quantitatively by its ratio with the T2 values in the normal spinal cord, including signal ratio and contrast ratio.Results: The number of discs adjacent to T2 high-intensity lesions was significantly higher in SCI than in CCM. The snake-eyes appearance was found in 9 of 20 CCM patients, but not in SCI patients. The signal ratio and contrast ratio on axial images were significantly higher in SCI than in CCM. A new diagnostic scale was created based on these results. This diagnostic scale has made it possible to distinguish SCI and CCM with >90% accuracy from all perspectives including sensitivity, specificity, positive predictive value, and negative predictive value.Conclusions: The features of T2 high-intensity lesions can be used to distinguish between SCI and CCM.

Do Intraoperative Neurophysiological Changes During Decompressive Surgery for Cervical Myeloradiculopathy Affect Functional Outcome? A Prospective Study

Study Design: Prospective cohort. Objective: To investigate whether intraoperative neuromonitoring (IONM) positive changes affect functional outcome after surgical intervention for myeloradiculopathy secondary to cervical compressive pathology (cervical compressive myelopathy). Methods: Twenty-eight patients who underwent cervical spine surgery with IONM for compressive myeloradiculopathy were enrolled. During surgery motor-evoked potential (MEP) and somatosensory evoked potential (SSEP) at baseline and before and after decompression were documented. A decrease in latency >10% or an increase in amplitude >50% was regarded as a “positive changes.” Patients were divided into subgroups based on IONM changes: group A (those with positive changes) and group B (those with no change or deterioration). Nurick grade and modified Japanese Orthopaedic Association (mJOA) score were evaluated before and after surgery. Results: Nine patients (32.1%) showed improvement in MEP. The mean preoperative Nurick grade and mJOA score of group A and B were (2.55 ± 0.83 and 11.11 ± 1.65) and (2.47 ± 0.7 and 11.32 ± 1.24), respectively. The mean postoperative Nurick grade of groups A and B at 6 months was 1.55 ± 0.74 and 1.63 ± 0.46, respectively, and this difference was not significant. The mean postoperative mJOA score of groups A and B at 6 months was 14.3 ± 1.03 and 12.9 ± 0.98, respectively, and this difference was statistically significant ( P = .011). Spearman correlation coefficient showed significant positive correlation between the IONM change and the mJOA score at 6 months postoperatively ( r = 0.47; P = .01). Conclusion: Our study shows that impact of positive changes in MEP during IONM reflect in functional improvement at 6 months postoperatively in cervical compressive myelopathy patients.

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

Improvement of sagittal parameters in patients with cervical spondylotic myelopathy is associated with outcome after anterior cervical discectomy and fusion

Purpose: After ACDF, cervical lordosis loss, high C2-7 SVA and postoperative T1S will worsen the surgical prognosis. Therefore, this study evaluated the changes of cervical parameters after surgery and correlation with surgical prognosis. Methods: This study enrolled 212 cervical compressive myelopathy patients who underwent ACDF. We collect gender, age, BMI, NDI scores and cervical parameters. And then, we compare the changes of parameters after surgery, and explore the correlation between parameters and NDI score. Results: C2-7 Cobb Angle, SVA, T1S and TS-CL were all improved after surgery, but T1S at the last follow-up was larger than that before the surgery. T1S is positively correlated with TIA (p=0.018, r=0.081), CL (p<0.01, r=0.150) and SVA (p<0.01, r=0.131), but negatively correlated with SCA (p<0.01, r=-0.166). We also found that TIA was highly correlated with the sum of T1S+NT (p<0.01, r=0.459). Preoperative NDI was negatively correlated with preoperative c2-7 Cobb Angle (r=-0.147, p=0.033), positively correlated with SVA (r=0.157, p=0.022). The last follow-up NDI score was negatively correlated with C2-7 Cobb Angle (r=-0.222 p=0.001), positively correlated with SVA (r=0.498, p<0.001) and TS-CL (r=0.165, p=0.016). The risk factors with poor follow-up NDI score (the last follow-up NDI score greater than 30%) were SVA (B=0.337, P=<0.001), CL (B=-0.147, P=0.029) and gender (B=2.153, P=0.017). Conclusions: After ACDF, most postoperative cervical parameters have improved, but T1S deteriorated over time. There was a close correlation between cervical sagittal parameters. Preoperative NDI score was correlated with c2-7 Cobb Angle and SVA. Follow-up NDI score was correlated with CL, TS-CL and SVA. High SVA, loss of cervical lordosis and male patient were risk factors for the deterioration of postoperative NDI score.