Does chronic cervical myelopathy affect respiratory function?

Toyoda, Hiromitsu; Nakamura, Hiroaki; Konishi, Sadahiko; Terai, Hidetomi; Takaoka, Kunio

doi:10.3171/spi.2004.1.2.0175

Cited by 37 publications

(41 citation statements)

References 14 publications

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“…The study also showed that although there was a significant improvement in the FVC values, the improvement did not equal the control values. The results were commensurate to the earlier studies by Toyoda et al 17 and Ishibe and Takahashi, 9 in which they reported lower values for % vital capacity (%VC), %FVC, PEFR, and increased respiratory rate and expiratory velocities at 50% and 25% of vital capacity. Yanaka et al 18 re- ported low tidal volumes that showed significant improvement after surgery.…”

Section: Discussionsupporting

confidence: 81%

“…13,17 The studies considered in this review suggest that the abnormality is subclinical, can involve inspiratory or expiratory flow differently, and can be complete or incomplete.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…13,17 It is important to evaluate these patients for subclinical respiratory dysfunction because of their high risk of intraoperative and postoperative respiratory complications. 17 …”

Section: Review Of the Literaturementioning

confidence: 99%

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Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation

Bhagavatula¹,

Bhat²,

Sasidharan

et al. 2016

FOC

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OBJECTIVE Respiratory abnormalities are well documented in acute spinal cord injury; however, the literature available for respiratory dysfunction in chronic compressive myelopathy (CCM) is limited. Respiratory dysfunction in CCM is often subtle and subclinical. The authors studied the pattern of respiratory dysfunction in patients with chronic cord compression by using spirometry, and the clinical and surgical implications of this dysfunction. In this study they also attempted to address the postoperative respiratory function in these patients. METHODS A prospective study was done in 30 patients in whom cervical CCM due to either cervical spondylosis or ossification of the posterior longitudinal ligament (OPLL) was diagnosed. Thirty age-matched healthy volunteers were recruited as controls. None of the patients included in the study had any symptoms or signs of respiratory dysfunction. After clinical and radiological diagnosis, all patients underwent pulmonary function tests (PFTs) performed using a standardized Spirometry Kit Micro before and after surgery. The data were analyzed using Statistical Software SPSS version 13.0. Comparison between the 2 groups was done using the Student t-test. The Pearson correlation coefficient was used for PFT results and Nurick classification scores. A p value < 0.05 was considered significant. RESULTS Cervical spondylotic myelopathy (prolapsed intervertebral disc) was the predominant cause of compression (n = 21, 70%) followed by OPLL (n = 9, 30%). The average patient age was 45.06 years. Degenerative cervical spine disease has a relatively younger onset in the Indian population. The majority of the patients (n = 28, 93.3%) had compression at or above the C-5 level. Ten patients (33.3%) underwent an anterior approach and discectomy, 11 patients (36.7%) underwent decompressive laminectomy, and the remaining 9 underwent either corpectomy with fusion or laminoplasty. The mean preoperative forced vital capacity (FVC) (65%) of the patients was significantly lower than that of the controls (88%) (p < 0.001). The mean postoperative FVC (73.7%) in the patients showed significant improvement compared with the preoperative values (p = 0.003). The mean postoperative FVC was still significantly lower than the control value (p = 0.002). The mean preoperative forced expiratory volume in 1 second (FEV1) (72%) of the patients was significantly lower than that of the controls (96%) (p < 0.001). The mean postoperative FEV1 (75.3%) in the cases showed no significant improvement compared with the preoperative values (p = 0.212). The mean postoperative FEV1 was still significantly lower than the control value (p < 0.001). The mean postoperative FEV1/FVC was not significantly different from the control value (p = 0.204). The mean postoperative peak expiratory flow rate was significantly lower than the control value (p = 0.01). The mean postoperative maximal voluntary ventilation was still significantly lower than the control value (p < 0.001). On correlating the FVC and Nurick scores using the Pearson correlation coefficient, a negative correlation was found. CONCLUSIONS There is subclinical respiratory dysfunction and significant impairment of various lung capacities in patients with CCM. The FVC showed significant improvement postoperatively. Respiratory function needs to be evaluated and monitored to avoid potential respiratory complications.

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Section: Discussionsupporting

confidence: 81%

“…13,17 The studies considered in this review suggest that the abnormality is subclinical, can involve inspiratory or expiratory flow differently, and can be complete or incomplete.…”

Section: Review Of the Literaturementioning

confidence: 99%

See 1 more Smart Citation

Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation

Bhagavatula¹,

Bhat²,

Sasidharan

et al. 2016

FOC

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“…In a small cohort of CSM patients, however, Yanaka et al, 22 who demonstrated a postoperative increase of tidal volume with a reduction of PCO 2 , failed to find such a favorable effect of surgery on %VC. Also as for %VC, Toyoda et al 5 reported that the CCM group showed significantly lower values than the control group with a further decrease for the CCM group with a higher lesion level of C3-4. All these studies, however, did not test MVV, which might be able to assess the subclinical impairment of ventilatory muscle coordination.…”

Section: Discussionmentioning

confidence: 99%

“…The ventilatory function in CSM, however, has not been investigated as extensively as that in cervical spinal cord injury (SCI); [1][2][3] only a few studies 4,5 have attempted to demonstrate a difference in routine spirometric data and flow volume curves between chronic-onset cervical myelopathies with various etiologies and control groups with lumbar lesions. However, those studies did not use the maximum voluntary ventilation (MVV) test, which, in one study, 6 has been shown to be more sensitive than vital capacity (VC) and forced expiratory volume in 1 s (FEV 1 ) to the improved respiratory endurance after a form of respiratory muscle training in athletes.…”

Section: Introductionmentioning

confidence: 99%

Maximum voluntary ventilation as a sensitive measure to monitor the ventilatory function in cervical spondylotic myelopathy

et al. 2012

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Study design: A prospective clinical cohort study. Objectives: To test if maximum voluntary ventilation (MVV), which is currently underutilized in diseases, serves for assessing subclinical ventilatory impairment in cervical spondylotic myelopathy (CSM). Setting: Kochi Medical School, Japan. Methods: We studied ventilatory function in 49 CSM patients and 20 age-and sex-matched control patients with either lumbar stenosis or lower limb osteoarthritis. All patients underwent ventilatory function studies consisting of flow volume curves, vital capacity (VC) and the MVV in 12 s before and after surgery. Tetraparesis was assessed by the functional scale of the Japanese Orthopaedic Association (JOA). Results: The CSM group had significantly smaller %forced VC , %peak expiratory flow rate (%PEFR) and %MVV than the control group preoperatively. In contrast to the control group, the CSM group showed a significant increase in %MVV from 74.9±18.7% preoperatively to 80.3 ± 19.0% postoperatively (Po0.005), but not in any other ventilatory measures. This postoperative increase in %MVV significantly correlated with the JOA score (r¼0.493; Po0.001). As a possible effect of diaphragmatic recovery, the %PEFR significantly increased postoperatively only in patients with the primary site of involvement at or rostral to C3-4. Conclusion: Of the various ventilatory measurements, MVV was most sensitive to changes in tetraparesis in CSM, presumably because MVV, unlike the other ventilatory measures, reflects the coordination in addition to the strength of respiratory muscles.

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Restrictive ventilatory impairment improved by laminoplasty for ossification of the posterior longitudinal ligament

Nishida

Ishiguro

Ota

et al. 2018

Clinical Case Reports

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Key Clinical Message We report a woman with severe restrictive ventilatory impairment because of respiratory muscle paralysis caused by ossification of the posterior longitudinal ligament (OPLL). Laminoplasty improved her respiratory function and quality of life. Cervical myelopathy including OPLL should be considered as an important differential diagnosis in patients with respiratory dysfunction.

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Does chronic cervical myelopathy affect respiratory function?

Cited by 37 publications

References 14 publications

Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation

Subclinical respiratory dysfunction in chronic cervical cord compression: a pulmonary function test correlation

Maximum voluntary ventilation as a sensitive measure to monitor the ventilatory function in cervical spondylotic myelopathy

Restrictive ventilatory impairment improved by laminoplasty for ossification of the posterior longitudinal ligament

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