Cervical spondylotic myelopathy in the young adult: A review of the literature and clinical diagnostic criteria in an uncommon demographic

Amenta, Peter S.; Ghobrial, George M.; Krespan, Kelly; Nguyen, Phi; Ali, Muhammed; Harrop, James S.

doi:10.1016/j.clineuro.2014.02.019

Cited by 28 publications

(25 citation statements)

References 29 publications

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“…Although previously used diagnostic criteria for DCM were neither standardized nor consistent across published studies, recent and current studies have defined DCM by the presence of at least one neurological sign and at least one neurological symptom in addition to a positive MRI for compression of the cord (Amenta et al., 2014; Kalsi‐Ryan, Karamidas, & Fehlings, 2013). …”

Section: Discussionmentioning

confidence: 99%

“…Baseline characteristics in relation to the development of symptomatic cervical myelopathy should be considered as preliminary predictors awaiting further confirmation.Reliable detection of especially early stages of symptomatic DCM is a crucial point of the study. Although previously used diagnostic criteria for DCM were neither standardized nor consistent across published studies, recent and current studies have defined DCM by the presence of at least one neurological sign and at least one neurological symptom in addition to a positive MRI for compression of the cord(Amenta et al, 2014;Kalsi-Ryan, Karamidas, & Fehlings, 2013).Definition of MRI criteria for degenerative cervical cord compression is essential for reliable and reproducible diagnosis of DCM. In general, spinal cord compression can be described based on the appearance or by measuring a ratio between the anteroposterior diameter at the compressed site and that of a noncompressed site, a ratio between the anteroposterior diameter and the transverse diameter (i.e., CR), or CSA at the region of compression(Nouri, Martin, Mikulis, & Fehlings, 2016).…”

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confidence: 99%

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Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

et al. 2017

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ObjectivesTo update a previously established list of predictors for neurological cervical cord dysfunction in nonmyelopathic degenerative cervical cord compression (NMDCCC).Material and MethodsA prospective observational follow‐up study was performed in a cohort of 112 consecutive NMDCCC subjects (55 women and 57 men; median age 59 years, range 40–79 years), either asymptomatic (40 subjects) or presenting with cervical radiculopathy or cervical pain (72 subjects), who had completed a follow‐up of at least 2 years (median duration 3 years). Development of clinical signs of degenerative cervical myelopathy (DCM) as the main outcome was monitored and correlated with a large number of demographic, clinical, electrophysiological, and MRI parameters including diffusion tensor imaging characteristics (DTI) established at entry.ResultsClinical evidence of the first signs and symptoms of DCM were found in 15 patients (13.4%). Development of DCM was associated with several parameters, including the clinical (radiculopathy, prolonged gait and run‐time), electrophysiological (SEP, MEP and EMG signs of cervical cord dysfunction), and MRI (anteroposterior diameter of the cervical cord and cervical canal, cross‐sectional area, compression ratio, type of compression, T2 hyperintensity). DTI parameters showed no significant predictive power. Multivariate analysis showed that radiculopathy, cross‐sectional area (CSA) ≤ 70.1 mm2, and compression ratio (CR) ≤ 0.4 were the only independent significant predictors for progression into symptomatic myelopathy.ConclusionsIn addition to previously described independent predictors of DCM development (radiculopathy and electrophysiological dysfunction of cervical cord), MRI parameters, namely CSA and CR, should also be considered as significant predictors for development of DCM.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

et al. 2017

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“…Early decompression improves manual dexterity. Neurological deficits in the upper extremities are considered the second most frequent and debilitating symptom of DCM in patients (38). For this reason, we characterized the upper limb deficits of mice with DCM before and after surgical decompression, using the wire hang test (39) and the Capellini handling test (40).…”

Section: Figure 2 Surgical Decompression Reduces Compression Ratio (A)mentioning

confidence: 99%

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

Vidal¹,

Karadimas²,

Ulndreaj³

et al. 2017

JCI Insight

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Degenerative cervical myelopathy (DCM) is the most common progressive nontraumatic spinal cord injury. The most common recommended treatment is surgical decompression, although the optimal timing of intervention is an area of ongoing debate. The primary objective of this study was to assess whether a delay in decompression could influence the extent of ischemia-reperfusion injury and alter the trajectory of outcome in DCM. Using a DCM mouse model, we show that decompression acutely led to a 1.5- to 2-fold increase in levels of inflammatory cytokines within the spinal cord. Delayed decompression was associated with exacerbated reperfusion injury, astrogliosis, and poorer neurological recovery. Additionally, delayed decompression was associated with prolonged elevation of inflammatory cytokines and an exacerbated peripheral monocytic inflammatory response (P < 0.01 and 0.001). In contrast, early decompression led to resolution of reperfusion-mediated inflammation, neurological improvement, and reduced hyperalgesia. Similar findings were observed in subjects from the CSM AOSpine North America and International studies, where delayed decompressive surgery resulted in poorer neurological improvement compared with patients with an earlier intervention. Our data demonstrate that delayed surgical decompression for DCM exacerbates reperfusion injury and is associated with ongoing enhanced levels of cytokine expression, microglia activation, and astrogliosis, and paralleled with poorer neurological recovery.

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“…32 Concomitant presence of changes in the upper limbs, such as weakness, numbness or loss of manual skills (such as writing), associated with gait changes, should further increase the degree of suspicion of CSM. 6 …”

Section: Presentationmentioning

confidence: 99%

“…However, there is wide variation in diagnosis and symptoms presented by patients suffering criteria. 6 A wide variety of clinical presentation, multiple treatments available and different backgrounds and diagnostic skills of orthopedists, neurologists, neurosurgeons, physiatrists and physical therapists, makes it difficult to approach universally. Still, despite its general prevalence, many patients with CSM are followed only by neurosurgeons or orthopedists, instead of neurologists.…”

Section: Introductionmentioning

confidence: 99%

Cervical spondylotic myelopathy: what the neurologist should know

et al. 2016

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Cervical spondylotic myelopathy is a well-known cause of disability among older people. A significant amount of these patients is asymptomatic. Once the symptoms start, the worsening may follow a progressive manner. We should suspect of spondylotic myelopathy in any individual over 55 years presenting progressive changes in gait or losing fine motor control of the upper limbs. Despite its frequent prevalence, this condition is still neglected and many times confused with other supratentorial lesions regarding diagnostic. Here we address some of most important aspects of this disease, calling attention to pathophysiology, the natural history, presentation, differential diagnosis, clinical assessment, and treatment.

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Cervical spondylotic myelopathy in the young adult: A review of the literature and clinical diagnostic criteria in an uncommon demographic

Cited by 28 publications

References 29 publications

Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression

Delayed decompression exacerbates ischemia-reperfusion injury in cervical compressive myelopathy

Cervical spondylotic myelopathy: what the neurologist should know

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