Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

Holly, Langston T.; Matz, Paul G.; Anderson, Paul A.; Groff, Michael W.; Heary, Robert F.; Kaiser, Michael G.; Mummaneni, Praveen V.; Ryken, Timothy C.; Choudhri, Tanvir F.; Vresilovic, Edward J.; Resnick, Daniel K.

doi:10.3171/2009.1.spine08718

Cited by 107 publications

(73 citation statements)

References 19 publications

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“…3 We found that pre-surgical CMCT at the lower limbs can predict functional recovery. Thus, our work further supports this view 5 and refutes studies with opposite findings.…”

Section: Discussionmentioning

confidence: 98%

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Transcranial magnetic stimulation but not MRI predicts long-term clinical status in cervical spondylosis: a case series

Deftereos¹,

Kechagias²,

Ioakeimidou³

et al. 2015

Spinal Cord

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Study Design: Case series. Objective: To compare transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI) findings between patients who underwent surgery for cervical spondylotic myelopathy and those with spondylosis who were not operated upon, and to correlate these findings with clinical functionality at follow-up. Setting: Private practice. Methods: Of 16 consecutive patients with cervical spondylosis 8 underwent surgery (group I) and 8 were treated conservatively (group II). We compared TMS and MRI findings between these groups and we correlated central motor conduction times (CMCTs) and MRImeasured sagittal and parasagittal diameters of the spinal canal at baseline evaluation, with clinical functionality at 2-year follow-up. Results: Group I CMCTs at the lower limbs correlated significantly with modified-JoA 2 years post surgery (r = − 0.71, Po0.05), but MRI-measured diameters did not. In group II baseline TMS was unrevealing, contrary to significant spinal stenosis disclosed by MRI. The condition of none of these patients deteriorated at 2 years. Conclusions: CMCTs at the lower limbs, but not cervical spinal canal diameters, correlate with long-term functional outcome following surgical or conservative treatment. Spinal Cord (2015) 53, S16-S18; doi:10.1038/sc.2014.220 INTRODUCTIONWhether magnetic resonance imaging (MRI) and transcranial magnetic stimulation (TMS) can predict long-term clinical outcomes in patients with cervical spondylosis is an issue of debate. 1-3 We compared TMS and MRI findings between a group of patients who underwent surgery for cervical spondylotic myelopathy and a second group with spondylosis, who were not operated upon, and we correlated these abnormalities with longitudinal clinical follow-up.

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“…3 We found that pre-surgical CMCT at the lower limbs can predict functional recovery. Thus, our work further supports this view 5 and refutes studies with opposite findings.…”

Section: Discussionmentioning

confidence: 98%

“…1- 3 We compared TMS and MRI findings between a group of patients who underwent surgery for cervical spondylotic myelopathy and a second group with spondylosis, who were not operated upon, and we correlated these abnormalities with longitudinal clinical follow-up.…”

Section: Introductionmentioning

confidence: 99%

Transcranial magnetic stimulation but not MRI predicts long-term clinical status in cervical spondylosis: a case series

Deftereos¹,

Kechagias²,

Ioakeimidou³

et al. 2015

Spinal Cord

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“…Therefore, some surgeons would suggest early surgery for patients with CSM to ameliorate the risk of SCI. 2,9,19,21,22,24,27,33 However, there are insufficient data to correlate CSM with SCI, and whether the risk of SCI can be altered by surgical intervention remains elusive.…”

mentioning

confidence: 99%

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Chen¹,

Chen³

et al. 2016

FOC

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OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p < 0.001). CONCLUSIONS Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.

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“…In a complementary article, Holly et al 6 efficiently summarized our current knowledge of the clinical prognostic indicators of surgical outcomes in CSM. There is consistent Class III evidence that the duration of symptoms, and possibly advancing age, negatively affect outcome.…”

Section: Cervical Spondylotic Myelopathymentioning

confidence: 99%

“…Holly et al, 6 in their excellent summary of the clinical prognostic indicators of surgical outcomes in CSM, showed that there is Class II evidence that somatosensory evoked potentials, and in particular recordings obtained following stimulation of the median nerve, have prognostic power. The use of EMGs has not been convincingly shown to be predictive of recovery in either myelopathy or radiculopathy, and there is conflicting Class III evidence regarding its predictive power (see the article by Mummaneni et al 15 in this issue).…”

Section: Predictive Value Of Electrophysiology and Imaging In Csmmentioning

confidence: 99%

Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome

Fehlings

Arvin

2009

SPI

103

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In this special edition of Journal of Neurosurgery: Spine, a series of systematic reviews sponsored by the Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons/Congress of Neurological Surgeons is presented. This collection of comprehensive reviews summarizes the medical evidence related to the surgical management of cervical degenerative disc disease. Several of the key conclusions are discussed in this introduction to the issue: There is Class II evidence to suggest that the clinical condition remains stable when observed over a 3-year period in patients with mild-to-moderate cervical spondylotic myelopathy (CSM) and age younger than 75 years. There is consistent Class III evidence that the duration of symptoms, and possibly advancing age, negatively affect outcome in patients with CSM. There is Class II evidence that somatosensory evoked potentials have prognostic value in patients with CSM. There is Class I evidence to show that electromyographic abnormalities (as well as the presence of radiculopathy) are predictive of the development of myelopathy in minimally symptomatic patients with cervical stenosis and spinal cord compression. The presence of a low signal on T1-weighted images, high signal on T2-weighted images, and the presence of cord atrophy on preoperative MR images are indicators of a poor outcome in CSM. There is Class III evidence to show that anterior or posterior surgical approaches that effectively decompress the cervical canal promote short-term improvements in outcome. However, there appears to be a risk of late kyphosis in patients who undergo laminectomy or anterior cervical discectomy alone compared with patients in whom decompression is combined with fusion. The use of BMP-2 is discouraged for anterior cervical spine surgery based on evidence suggesting that the risks outweigh any potential benefits. Finally, in patients with symptomatic cervical radiculopathy, arthroplasty achieves outcomes that are equivalent to anterior cervical decompression and fusion, although evidence for superiority is lacking. Further prospective longitudinal data are required to better define the role and timing of surgical intervention in CSM and to determine the appropriate use of cervical arthroplasty in the management of symptomatic cervical degenerative disc disease.

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Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy

Cited by 107 publications

References 19 publications

Transcranial magnetic stimulation but not MRI predicts long-term clinical status in cervical spondylosis: a case series

Transcranial magnetic stimulation but not MRI predicts long-term clinical status in cervical spondylosis: a case series

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome

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