Predictors of Surgical Outcome in Cervical Spondylotic Myelopathy

Karpova, Alina; Arun, R; Davis, Aileen M.; Kulkarni, Abhaya V.; Massicotte, Eric M.; Mikulis, David J.; Lubina, Ivan Zvonimir; Fehlings, Michael G.

doi:10.1097/brs.0b013e3182715bc3

Cited by 94 publications

(85 citation statements)

References 25 publications

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“…The Japanese Orthopaedic Association motor scoring system has been used previously for children with cervical spine instability 9,18 . Additionally, in some but not all studies of patients with degenerative cervical spine disease, the Japanese Orthopaedic Association motor scoring system has been a predictor of outcome of decompressive surgery for cervical spondylolytic myelopathy 19,20 and has also shown a correlation with preoperative central motor conduction time as measured with transcranial magnetic stimulation 21 . Although some of the questions are clearly related to Japanese culture, we believe that the scoring system contains useful data on cervical spinal cord deficits in children with various cultural backgrounds.…”

Section: Discussionmentioning

confidence: 99%

Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Helenius¹,

Crawford²,

Sponseller³

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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Section: Discussionmentioning

confidence: 99%

Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Helenius¹,

Crawford²,

Sponseller³

et al. 2015

The Journal of Bone and Joint Surgery-American Volume

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“…This time frame implicates inherent regenerative or plastic changes within the spinal cord. Nevertheless, many patients remain disabled [29], and there are nonsurgical treatments available for improving outcome for CSM.…”

Section: Introductionmentioning

confidence: 99%

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Dhillon

Parker

Syed

et al. 2016

acta neuropathol commun

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Cervical spondylotic myelopathy (CSM) is the most common spinal cord disorder and a major cause of disability in adults. Improvements following surgical decompression are limited and patients often remain severely disabled. Post mortem studies indicate that CSM is associated with profound axonal loss. However, our understanding of the pathophysiology of CSM remains limited.To investigate the hypothesis that axonal plasticity plays a role in the recovery following surgical decompression, we adopted a novel preclinical model of mild to moderate CSM. Spinal cord compression resulted in significant locomotor deterioration, increased expression of the axonal injury marker APP, and loss of serotonergic fibres. Surgical decompression partially reversed the deficits and attenuated APP expression. Decompression was also associated with axonal sprouting, reflected in the restoration of serotonergic fibres and an increase of GAP43 expression. The re-expression of synaptophysin indicated the restoration of functional synapses following decompression. Promoting axonal plasticity may therefore be a therapeutic strategy for promoting neurological recovery in CSM.Electronic supplementary materialThe online version of this article (doi:10.1186/s40478-016-0359-7) contains supplementary material, which is available to authorized users.

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“…The mJOA score has been shown to be a predictor of outcomes after decompressive surgery for CSM. 33 In one study, severe myelopathy (JOA <7) was associated with a good outcome in 55% of patients versus 70% in patients with mild disease. 34 Others have reported that CMCT correlates with mJOA at both preoperative and postoperative time points in patients with severe CSM 1,2,12 .…”

Section: Discussionmentioning

confidence: 96%

Transcranial Magnetic Stimulation of the Motor Cortex Correlates With Objective Clinical Measures in Patients With Cervical Spondylotic Myelopathy

Mazur¹,

White²,

McEvoy³

et al. 2014

Spine

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Study Design Prospective cohort study Objective To assess the correlation between central motor conduction time (CMCT) and various subjective and objective clinical assessment measures in patients with cervical spondylotic myelopathy (CSM) undergoing decompressive surgery Summary of Background Data CSM can cause a spectrum of neurological deficits across individuals. Subjective clinical assessments of disease severity may lack the sensitivity of objective tests. Transcranial magnetic stimulation (TMS) provides objective electrophysiologic data on the integrity of the corticospinal tracts, which may be useful for monitoring disease progression or neurological improvement after surgery. Methods Patients undergoing surgical decompression for CSM performed subjective and objective testing before surgery and at 1, 3, 6 and 12 months after surgery. Subjective measures included modified Japanese Orthopaedic Assessment (mJOA), Neck Disability Index (NDI), Nurick grade, and visual analog scale (VAS) score. Objective measures included CMCT as measured using TMS, the 10-meter walk test (10MWT), the 9-hole peg task (9HPT), and grip and release test (GRT). Primary outcome was the correlation between CMCT and subjective or objective measures at preoperative and postoperative time points. Secondary outcome was the correlation between preoperative CMCT and performance in subjective or objective testing after surgical intervention. Results Improvement in both subjective and objective measures was observed after surgery. CMCT correlated with other objective measures (10MWT, 9HPT, and GRT) both at baseline and after decompressive surgery in these 17 patients with CSM. Patients with high baseline CMCTs were associated with poor performance on the 10MWT, 9HPT, and GRT. mJOA correlated with CMCT at baseline but not after surgical intervention. CMCT was not associated with other subjective measures, such as NDI, Nurick grade, and VAS, at preoperative or postoperative time points. Conclusion CMCT as measured by TMS is a responsive objective assessment of CSM. It can be used to monitor disease severity and neurological function before and after surgical intervention. Prolonged baseline CMCT may be associated with worse surgical outcomes.

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Predictors of Surgical Outcome in Cervical Spondylotic Myelopathy

Cited by 94 publications

References 25 publications

Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy

Transcranial Magnetic Stimulation of the Motor Cortex Correlates With Objective Clinical Measures in Patients With Cervical Spondylotic Myelopathy

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