Is extensive cervical laminoplasty an effective treatment for spinal cord sarcoidosis combined with cervical spondylosis?

Abstract

Patients with neurosarcoidosis are usually initially treated with steroid administration even when they have concomitant cord compression on magnetic resonance imaging (MRI). Operative intervention may be indicated in patients with spinal cord sarcoidosis requiring either tissue biopsy for diagnosis or associated with progressive neurologic symptoms. However, there have been no previous reports describing clinical outcomes of laminoplasty for spinal cord sarcoidosis. The objectives of this study are to investigate whether extensive cervical laminoplasty is an effective treatment for spinal cord sarcoidosis combined with spondylotic changes and/or cervical spinal canal stenosis. Open-door laminoplasty was performed in three patients with spinal cord sarcoidosis. All patients received intensive corticosteroid therapy after the operation MRI imaging was performed in all patients before and after the operation. Operative outcomes were not satisfactory and the clinical courses of the patients fluctuated after corticosteroid therapy. Daily life activities were not significantly improved after treatments in any of the three patients, and in the long-term follow-up period the clinical course of one patient was one of inexorable deterioration to a state of quadriplegia. The possibility of spinal cord sarcoidosis should be included in the differential diagnosis, when a distinct high signal intensity area is observed within the spinal cord on T2-weighted MR images in patients with spondylotic changes. Laminoplasty is not an effective intervention for the treatment of spinal cord sarcoidosis even when patients have spondylotic changes and/or a constitutionally narrowing cervical spinal canal. Patients with neurosarcoidosis should be treated first with steroid administration even when they have concomitant cord compression on MRI.

Spinal Magnetic Resonance Imaging Manifestations at Neurological Onset in Japanese Patients with Spinal Cord Sarcoidosis

“…Based on these previous results and our present findings, spinal cord sarcoidosis and cervical spondylosis occur coincidentally at the same spinal cord level more commonly than previously thought and overlap each other. Oe et al (8) recommended that patients with neurosarcoidosis be treated first with steroids, regardless of the presence of concomitant cord compression on MR imaging, because laminoplasty is not an effective intervention for the treatment of spinal cord sarcoidosis, even when the patient has spondylosis and/or constitutional narrowing of the cervical spinal canal. Therefore, conducting a more careful evaluation of spinal cord sarcoidosis is required in patients with intramedullary T2-elongated lesions and spondylosis on spinal MR imaging.…”

“…There are several case reports and research studies of spinal cord sarcoidosis on MR imaging; however, most of these articles have been reported in Western countries. There have been only a few research reports describing the initial MR findings in Japanese patients with spinal cord sarcoidosis (7)(8)(9). Therefore, further exploration and accumulation of cases of spinal cord sarcoidosis is necessary due to the rarity of this condition.…”

Clinical features of spinal cord sarcoidosis: analysis of 17 neurosarcoidosis patients

“…Spinal cord sarcoidosis exhibits intramedullary high-intensity signals on T2-weighted images (T2WI) and enhancements on gadolinium (Gd) DTPA-enhanced T1 weighted images (Gd-T1WI) [4,5]; however, these signs also resemble cervical myelopathy with spondylosis [6]. Although cervical spondylotic myelopathy, which is common in elderly persons, sometimes mimics spinal cord sarcoidosis, a similar operative treatment is not effective for spinal cord sarcoidosis with cervical spondylosis [7]. Therefore, the diagnosis of spinal sarcoidosis is important for effective treatment.…”

FDG-PET SUV can distinguish between spinal sarcoidosis and myelopathy with canal stenosis

“…In addition, the appearance of spinal cord sarcoidosis in cervical magnetic resonance imaging (MRI) sometimes resembles that of spondylotic myelopathy or other non-inflammatory spinal cord lesions [3]. In cases of cervical spondylosis associated with spinal cord sarcoidosis, extensive cervical laminoplasty has been shown to be ineffective [3].…”

“…In cases of cervical spondylosis associated with spinal cord sarcoidosis, extensive cervical laminoplasty has been shown to be ineffective [3]. Furthermore, treatment of spinal cord sarcoidosis with, for example, corticosteroids is quite different these other diseases.…”