Prospects of cell replacement therapy for the treatment of degenerative cervical myelopathy

Shea, Graham Ka‐Hon; Koljonen, Paul Aarne; Chan, Ying-Shing

doi:10.1515/revneuro-2020-0075

Cited by 2 publications

(3 citation statements)

References 87 publications

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“…The information generated from this study shows that, in addition to previously reported inferior post-decompression recovery rates and final mJOA scores 21 , preoperative T2-weighted intramedullary signal changes are significantly associated with neurological decline. Such imaging findings reflect underlying cell loss and demyelination 22 , which may persist despite adequate surgical decompression 23 .…”

Section: Discussionmentioning

confidence: 99%

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy

Yick

Zhang

Wong

et al. 2022

Journal of Bone and Joint Surgery

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Background: Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration.Methods: A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis.Results: The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019).Conclusions: Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally.Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Degenerative cervical myelopathy (DCM) is an acquired cause of spinal cord dysfunction estimated to affect 5% of the population over the age of 40 years 1 . Cervical spondylosis due to age-related degenerative changes to the intervertebral disc and facet joints is the predominant cause of canal narrowing in the middle-aged population, but ossification of the posterior longitudinal ligament (OPLL) accounts for a considerable case volume in the Asian population, with a tendency for affecting younger adults 2 . Surgical decompression of the cervical spinal cord is an effective means to prevent neurological deterio-ration and promote recovery in patients with DCM. Practice guidelines have recommended a surgical procedure for patients with moderate or severe symptoms according to the modified Japanese Orthopaedic Association (mJOA) score 1 . Short-term to intermediate-term outcomes of surgical decompression have been well described in the literature. Over 70% of patients have demonstrated neurological improvement postoperatively, with a slowing of recovery by 6 months 2 . The postoperative mJOA ...

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Section: Discussionmentioning

confidence: 99%

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy

Yick

Zhang

Wong

et al. 2022

Journal of Bone and Joint Surgery

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“…In addition to necropsy specimens, animal model correlates of DCM have been invaluable to understanding disease pathophysiology, and in highlighting differences from acute traumatic SCI [ 66 ]. Acute traumatic SCI models result in immediate neurological deterioration (i.e.…”

Section: Pathophysiology Of Degenerative Cervical Myelopathymentioning

confidence: 99%

“…In the polymer-implanted rat DCM model, a significant reduction in the number of blood vessels in white and grey matter of the cervical spinal cord was observed [ 75 ]. Ischemic injury precipitates apoptosis and inflammation, which can proceed to necroptosis as cord compression worsens [ 66 , 87 ].…”

Section: Pathophysiology Of Degenerative Cervical Myelopathymentioning

confidence: 99%

Blood-spinal cord barrier disruption in degenerative cervical myelopathy

Kim,

Yong,

Shea

2023

Fluids Barriers CNS

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Degenerative cervical myelopathy (DCM) is the most prevalent cause of spinal cord dysfunction in the aging population. Significant neurological deficits may result from a delayed diagnosis as well as inadequate neurological recovery following surgical decompression. Here, we review the pathophysiology of DCM with an emphasis on how blood-spinal cord barrier (BSCB) disruption is a critical yet neglected pathological feature affecting prognosis. In patients suffering from DCM, compromise of the BSCB is evidenced by elevated cerebrospinal fluid (CSF) to serum protein ratios and abnormal contrast-enhancement upon magnetic resonance imaging (MRI). In animal model correlates, there is histological evidence of increased extravasation of tissue dyes and serum contents, and pathological changes to the neurovascular unit. BSCB dysfunction is the likely culprit for ischemia–reperfusion injury following surgical decompression, which can result in devastating neurological sequelae. As there are currently no therapeutic approaches specifically targeting BSCB reconstitution, we conclude the review by discussing potential interventions harnessed for this purpose.

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Prospects of cell replacement therapy for the treatment of degenerative cervical myelopathy

Cited by 2 publications

References 87 publications

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy

Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy

Blood-spinal cord barrier disruption in degenerative cervical myelopathy

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