Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: a multivariate analysis

Zhang, JingTao; Cui, Can; Liu, Zhao; Tong, Tong; Niu, Ruijie; Shen, Yong

doi:10.1038/srep39512

Cited by 17 publications

(15 citation statements)

References 27 publications

(49 reference statements)

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“…Cervical spondylotic amyotrophy (CSA) is characterized by weakness and wasting of upper limb muscles without sensory or lower limb involvement [12][13][14]. The underlying mechanisms of CSA may involve damages to the ventral nerve rootlets, and vascular insufficiency to the anterior horn cells.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of different zones is important for the diagnosis of CSA. Compression of zone I may cause anterior spinal artery impingement leading to dysfunction of anterior horn cells, which may partially explain why a moderate compression of the central canal sometimes led to CSA [13]. The compression at zone II will impair the ventral nerve rootlets and anterior horn of spinal cord, which may cause motion dysfunction without sensation loss.…”

Section: Discussionmentioning

confidence: 99%

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A new anatomic zone division within the cervical spinal canal

Kong

Liu

Ya-dong

et al. 2020

Preprint

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Background: Detailed anatomical information is important for identifying the origin and anatomic basis of symptoms in cervical spondylosis patients, but very little quantitative data have been reported. This study characterized the morphologic features of cervical spinal nerve rootlets and defined different zones at cervical spinal canal to provide an anatomic basis for studying cervical spondylosis. Methods: Ten cervical spines from C2 to T1 were obtained for the present study. We defined three zones from midline to lateral part (zone I, II and III) and two zones from cranial to caudal (zone P and zone IP) on the coronal plane within the cervical spinal canal. Quantitative anatomy of the zones at different cervical segments were measured including: 1) horizontal widths of zone I, II and III;2) Length of the cervical spinal cord segment at the ventral rootlets (LV); 3) The pedicle height (PH, zone P) and the inter-pedicle height (IPH, zone IP); 4) The distance between the superior margin of pedicle and the exit of the uppermost ventral nerve rootlet (PN). Results: There was a trend that the horizontal widths of zone I gradually decrease from C4 to C8 but without significant differences (P=0.98). The value of zone II at C4 was significantly less than that at other levels (P=0.008). The value of zone III increases from C4 to C8, and the values at C7 and C8 were significantly higher than those at C4, C5 and C6 (P=0.032). PHs and IPHs were not significantly different between different levels (P1=0.365; P2=0.240). The values of LV at C4 and C8 were smaller than those of C5, C6 and C7 (P=0.001). The value of PN showed an increasing trend. At C4, the uppermost ventral rootlet was at about the same height as C3 pedicle, while C8 uppermost ventral rootlet was at the same level as the inferior part of C6 pedicle. Ventral intradural intersegmental connections were found in three intersegments (two specimens) out of 20 intersegments (15%). Conclusions: The current definition of anatomic zones may be useful for an accurate diagnosis of cervical spondylosis and a safe and effective anterior decompression surgery. BackgroundCervical spondylosis is often caused by degenerative disc disease which may lead to neck pain, radiculopathy, and myelopathy [1][2][3]. Theoretically, cervical radiculopathy is due to compression of the nerve roots, whereas cervical myelopathy is resulted from compression of the spinal cord.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A new anatomic zone division within the cervical spinal canal

Kong

Liu

Ya-dong

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Cervical spondylotic amyotrophy (CSA) is characterized by weakness and wasting of upper limb muscles without sensory or lower limb involvement [12][13][14]. The underlying mechanisms of CSA may involve damage to the ventral nerve rootlets and vascular insu ciency to the anterior horn cells.…”

Section: Discussionmentioning

confidence: 99%

“…Accurate diagnosis of CSA and precise surgery require a detailed characterization and de nition of different anatomical zones. Compression of zone I may cause anterior spinal artery impingement that leads to dysfunction of anterior horn cells, which may partially explain why a moderate compression of the central canal sometimes leads to CSA [13]. Compression at zone II will impair the ventral nerve rootlets and anterior horn of the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

A new anatomic zone division within the human cervical spinal canal

Kong

Liu

et al. 2020

Preprint

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Abstract Background: Anatomic details are important for identifying the origin and anatomic basis of symptoms in patients with cervical spondylosis. However, very little quantitative data has been reported. In an effort to provide an anatomic basis for the examination of cervical spondylosis mechanisms, we characterized the morphologic features of cervical spinal nerve rootlets and defined different zones of the human cervical spinal canal.Methods: In 10 cadaveric cervical cords from C2 to T1, we defined three zones bilaterally from the midline (zones I-III) and two zones from cranial to caudal (zones P and IP) on the coronal plane within the cervical spinal canal. We measured each anatomic zone, including 1) horizontal widths of zones I, II and III; 2) the length of the cervical spinal segment at the ventral rootlets (LV); 3) the pedicle height (zone P) and interpedicle height (zone IP); and 4) the distance between the superior margin of the pedicle and the exit of the uppermost ventral nerve rootlet (PN). Results: The horizontal widths of zone I tended to decrease gradually from C4 to C8 (p=0.98). The width of zone II at C4 was significantly less than that at other levels (p=0.008). The width of zone III increased from C4 to C8 and was significantly greater at C7 and C8 than at C4, C5, and C6 (p=0.032). Pedical and interpedical heights were not significantly different at different levels (p=0.365 and 0.240, respectively). LV values at C4 and C8 were smaller than those at C5, C6, and C7 (p=0.001). At C4, the uppermost ventral rootlet was at approximately the same height as the C3 pedicle, whereas at C8, the uppermost ventral rootlet was at the same level as the inferior part of the C6 pedicle. Ventral intradural intersegmental connections were found in three of 20 (15%) intersegments (two specimens).Conclusions: These anatomic zones may be useful for diagnosing cervical spondylosis and guiding anterior decompression surgery.

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“…Outcomes were correlated with patients undergoing anteiror cervical diskectomy/fusion (ACDF), anterior corpectomy/fusion (ACF), laminectomy with/without posterior fusion (LAM), and laminoplasty (LOP) [Tables 1 – 3 ; Figures 1 – 6 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 ] Several Types/Grades helped assess the severity/prognostic import of low cord signals (LCS) and high cord signals (HCS) on preoperative/postoperative MR studies; Type/Grade 0: no/absent low cord signal (LCS), Type/Grade 1: faint/fuzzy/mild/obscure LCS; Grade 2: middle/intense/sharp HCS; and Type/Grade 3: mixed/HCS. [ 1 5 8 14 ] Additionally, the location/extent of HCS on T2 sagittal MR studies also impacted outcome and were defined as: focal (single level), multifocal (with skip areas), and/or multisegmental (MS: >1 level; continuous).…”

Section: Introductionmentioning

confidence: 99%

High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review

Epstein¹

2018

Surg Neurol Int

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Background:High cord signals (HCS) on preoperative/postoperative T1, T1 gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA), and T2 magnetic resonance (MR) studies, postoperative failure of HCS to regress and/or cord re-expansion, and a triangular cord configuration are poor prognostic factors for surgical patients with cervical spondylotic myelopathy (CSM).Methods:Here, we reviewed the negative prognostic import of high Grades/Types and more extensive locations of preoperative/postoperative HCS on T1, T1 Gd-DTPA, and T2 MR studies in surgical patients with CSM. Additional predictors of poor operative outcomes included postoperative failure of HCS to regress, cord re-expansion at the site of a HCS, and the triangular vs. teardrop or boomerang cord configuration. The Types/Grades of HCS on MR follow:Type/Grade 0 – no/absent signal changes; Type/Grade 1 – mild/light/fuzzy/obscure/low cord signal (LCS) changes; Type/Grade 2 – sharp/intense/well-defined HCS; and Type/Grade 3 – mixed/HCS. The definitions of location/extent of LCS/HCS were: focal (1 level), multifocal (with skip areas), and multisegmental (continuous over >1 segment), while cord configuration was categorized as triangular, teardrop, or boomerang.Results:On MR studies, preoperative/postoperative Types/Grades 0–1 changes correlated with better prognoses (e.g., improved Japanese Orthopedic Association (JOA) scores or Nurick Grades), while Types/Grades 2–3 correlated with poorer outcomes. Multiple poor prognostic indicators also included; failure of postoperative HCS on MR to regress (particularly if multisegmental), postoperative cord re-expansion at the site of a prior HCS, and triangular cord configuration.Conclusions:Grade/Types 2–3 HCS on T1, T1 Gd-DTPA, and T2-weighted MR images on preoperative/postoperative MR studies, failure of HCS to regress (multisegmental), cord re-expansion at the site of a prior HCS, and a triangular cord configuration (atrophy) all contributed to poorer outcomes for CSM surgery.

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Predisposing factors for poor outcome of surgery for cervical spondylotic amyotrophy: a multivariate analysis

Cited by 17 publications

References 27 publications

A new anatomic zone division within the cervical spinal canal

A new anatomic zone division within the cervical spinal canal

A new anatomic zone division within the human cervical spinal canal

High cord signals on magnetic resonance and other factors predict poor outcomes of cervical spine surgery: A review

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