Pathophysiology and Natural History of Cervical Spondylotic Myelopathy

Karadimas, Spyridon K.; Erwin, W. Mark; Ely, Claire G.; Dettori, Joseph R; Fehlings, Michael G.

doi:10.1097/brs.0b013e3182a7f2c3

Cited by 351 publications

(267 citation statements)

References 40 publications

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“…In a systematic review on the natural course of CSM, Karadimas et al reported that 20%-62% of patients will deteriorate neurologically at 3-6 years without surgical intervention. 15 Their review underscores the uncertainty of widely varied clinical presentation of CSM and the clinical dilemma that roughly half of patients may live with CSM without surgical treatment. The choice of optimal treatments and the timing of any intervention remain controversial and reflect a lack of reliable clinical and radiographical factors to predict patients who will experience deterioration.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…The mechanical factors are classified further into static and dynamic mechanical factors [1][2][3][4][5][6].…”

Section: Cervical Spondylotic Myelopathymentioning

confidence: 99%

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

Mardhika¹,

Marta²,

Maliawan³

et al. 2017

Recent Advances in Biology and Medicine

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This paper reviews the pathophysiology of cervical spondylotic myelopathy (CSM) and several surgical approaches for the treatment of CSM. CSM is a degenerative disease with severe morbidity. The pathophysiology of CSM involves static, dynamic, and ischemic factors. The management of mild CSM typically involves conservative treatments and medication; whereas, moderate and severe CSM are better treated surgically. Surgical treatments for CSM are basically classified into anterior and posterior surgeries. The common techniques are anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), laminectomy, and laminoplasty. Each technique has its own advantages and disadvantages. In this paper, we review the research papers from PubMed database to elaborate the advantages and disadvantages of each technique.

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“…, 1, 2 CSM in dogs shares similarities with cervical spondylotic myelopathy, the most common cause of chronic compressive cervical myelopathy in people 2, 3, 4. While surgical treatment can attenuate the progression of this human disease, many patients are left with substantial neurologic disability 3.…”

mentioning

confidence: 99%

“…Gaps in the knowledge of the disease pathobiology have historically limited therapeutic advances in this human condition and current studies are actively investigating the disease pathogenesis with the objective of developing new neuroprotective approaches to improve outcome 3, 4, 5, 6, 7, 8, 9. Rodent models of cervical spondylotic myelopathy show that neuronal and oligodendrocyte apoptosis, chronic neuroinflammation, and microvascular compromise result in progressive neural degeneration and potentially irreversible spinal cord (SC) damage and could be related to treatment failure, poor long‐term outcome, or both 3, 4, 5, 6, 7, 8, 9. Similar changes have been observed in the SC of CSM‐affected dogs 2.…”

mentioning

confidence: 99%

Cytokine Concentrations in the Cerebrospinal Fluid of Great Danes with Cervical Spondylomyelopathy

Martín-Vaquero

Costa

Moore

et al. 2014

Veterinary Internal Medicne

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BackgroundChronic inflammation is involved in the pathogenesis of human cervical spondylotic myelopathy and could also play a role in cervical spondylomyelopathy (CSM) in dogs.Hypothesis/ObjectivesThat cerebrospinal fluid (CSF) cytokine concentrations would differ between clinically normal (control) and CSM‐affected Great Danes (GDs), with affected GDs showing higher levels of inflammatory cytokines, such as interleukin (IL)‐6 and monocyte chemoattractant protein‐1/chemokine ligand 2 (MCP‐1/CCL2).AnimalsClient‐owned GDs: 15 control, 15 CSM‐affected.MethodsProspective study. Dogs underwent cervical vertebral column magnetic resonance imaging and collection of CSF from the cerebellomedullary cistern. Cytokine concentrations were measured using a commercially available canine multiplex immunoassay. Cytokine concentrations were compared between groups. Associations with the administration of anti‐inflammatory medications, disease duration and severity, severity of spinal cord (SC) compression, and SC signal changes were investigated in affected GDs.ResultsAffected GDs had significantly lower MCP‐1/CCL2 (mean 138.03 pg/mL, 95% confidence interval [CI] = 114.85–161.20) than control GDs (212.89 pg/mL, 95% CI = 165.68–260.11, P = .028). In affected GDs, MCP‐1/CCL2 concentrations correlated inversely with the severity of SC compression. There were no associations with administration of anti‐inflammatory medications, disease duration, or disease severity. IL‐6 concentrations were significantly higher (2.20 pg/mL, 95% CI = 1.92–2.47, P < .001) in GDs with SC signal changes.Conclusions and Clinical ImportanceLower MCP‐1/CCL2 in CSM‐affected GDs might compromise clearance of axonal and myelin debris, delay axon regeneration, and affect recovery. Higher IL‐6 in CSM‐affected GDs with SC signal changes suggests more severe inflammation in this group.

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Pathophysiology and Natural History of Cervical Spondylotic Myelopathy

Abstract: Strong. SUMMARY STATEMENTS: Chronic compression of the spinal cord results in progressive neural cell loss related to secondary mechanisms including apoptosis, neuroinflammation, and vascular disruption.

Cited by 351 publications

References 40 publications

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

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

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

Cytokine Concentrations in the Cerebrospinal Fluid of Great Danes with Cervical Spondylomyelopathy

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