Role of Cerebrolysin in cervical spondylotic myelopathy patients: a prospective randomized study

Allam, Ahmad Fouad Abdelbaki; Abotakia, Tarek Abdalla Ahmed; Koptan, Wael

doi:10.1016/j.spinee.2017.11.002

Cited by 13 publications

(10 citation statements)

References 18 publications

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“…Nouri et al 182 (2020) in a retrospective analysis of 725 patients undergoing surgery for DCM or degenerative cervical radiculopathy, demonstrated macrocytic anemia was more common in DCM, and its presence associated with poorer pre-operative neurological status . Further, Allam et al 183 (2017) (61) conducted a randomized controlled study (N = 192), in patients declining surgery for DCM of Cerebrolysin, a mixture of amino-acids and peptides given via intramuscular injection, demonstrating neurological benefit for the treatment arm.…”

Section: Introductionmentioning

confidence: 99%

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Davies

Mowforth

Gharooni

et al. 2022

Global Spine Journal

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Study Design Literature Review (Narrative) Objective To propose a new framework, to support the investigation and understanding of the pathobiology of DCM, AO Spine RECODE-DCM research priority number 5. Methods Degenerative cervical myelopathy is a common and disabling spinal cord disorder. In this perspective, we review key knowledge gaps between the clinical phenotype and our biological models. We then propose a reappraisal of the key driving forces behind DCM and an individual’s susceptibility, including the proposal of a new framework. Results Present pathobiological and mechanistic knowledge does not adequately explain the disease phenotype; why only a subset of patients with visualized cord compression show clinical myelopathy, and the amount of cord compression only weakly correlates with disability. We propose that DCM is better represented as a function of several interacting mechanical forces, such as shear, tension and compression, alongside an individual’s vulnerability to spinal cord injury, influenced by factors such as age, genetics, their cardiovascular, gastrointestinal and nervous system status, and time. Conclusion Understanding the disease pathobiology is a fundamental research priority. We believe a framework of mechanical stress, vulnerability, and time may better represent the disease as a whole. Whilst this remains theoretical, we hope that at the very least it will inspire new avenues of research that better encapsulate the full spectrum of disease.

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Section: Introductionmentioning

confidence: 99%

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

Davies

Mowforth

Gharooni

et al. 2022

Global Spine Journal

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“…Further, Allam et al (2017), 43 conducted a randomised controlled study ( N = 192), where patients declining surgery for DCM were given Cerebrolysin, a mixture of amino-acids and peptides given via intramuscular injection. Although, both arms improved on average without surgery (a methodological concern), this was more likely, and of greater magnitude, in the treatment arm as measured using the Japanese Orthopaedic Association score.…”

Section: Discussionmentioning

confidence: 99%

“…A randomised controlled trial reported that administering Cerebrolysin, a mixture of amino acids and biologically active peptides, to DCM patients who declined surgery, led to significant improvements in their myelopathy, including JOA scores and mean JOA recovery rate after 6 months. 43 Similarly, oral creatine supplementation was shown to enhance exercise capacity in patients with cervical spinal cord injury (SCI), significantly improving oxygen uptake, carbon dioxide production and tidal volume at peak effort, with associated significantly higher peak power output; although, there was no significant effect on respiratory exchange ratio, minute ventilation and time to fatigue. 44 The effect of malnutrition on adverse events: surgical outcomes and complications.…”

Section: Malnutrition and Electrolyte Imbalancementioning

confidence: 99%

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Partha-Sarathi

Mowforth

Sinha

et al. 2021

Nutr Metab Insights

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Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

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“…For this case, 30mg methylprednisolone per Kg of body weight was given intravenously within 15 minutes once neurological deterioration was found, and the medicine was used as reported in literatures [31]. Besides, dehydrate agents, neurotrophic and neuroprotective agents can be considered to protect and facilitate rehabilitation of spinal cord function, but there are short of consistent clinical evidence [22,[32][33]. Although often overlooked, compensation collateral circulation, including the system of epidural arcades in the immediate setting, and paraspinal collaterals in the long run, may play a role in functional recovery of spinal cord [34].…”

Section: Literature Reviewmentioning

confidence: 99%

Delayed Incomplete Paraplegia After En Bloc Spondylectomy of Thoracic Metastasis, A Case Report

Du¹,

Liu²,

Jia³

et al. 2020

Preprint

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Background: Delayed paraplegia after total en bloc spondylectomy (TES) is exceptionally rare, and from the best of our knowledge, no such cases were reported yet. Case presentation: We herein report a case of delayed paraplegia which happened after TES of a solitary thoracic metastasis from renal clear cell carcinoma. After thorough evaluation, the patient received TES to expect a long-term local control. In operation, the patient suffered a short period of low blood pressure (mean synthetic pressure ＜90mmHg) which happened during vertebral prosthesis implantation. After operation, the neurological status was just as preoperative level, however, the patient suffered incomplete paraplegia 10 hours later. His symptoms and clinical examinations were consistent with infarct of anterior spinal artery and ischemia syndrome of spinal cord. The patient was given hyperbaric oxygen therapy and rehabilitation exercises after the tragedy, and he got recovery 2 months later, and showed much better than preoperative status 12 months later. Possible reasons for the delayed paraplegia were discussed, and we carefully concluded that intraoperative hypotension and manipulation both contributed to the happening of anterior spinal artery infarction. Conclusions: Based on this case and literature review, keeping blood pressure above daily level and other precautionary measures for spinal cord ischemia were recommended.

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Role of Cerebrolysin in cervical spondylotic myelopathy patients: a prospective randomized study

Cited by 13 publications

References 18 publications

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

A New Framework for Investigating the Biological Basis of Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 5]: Mechanical Stress, Vulnerability and Time

The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Delayed Incomplete Paraplegia After En Bloc Spondylectomy of Thoracic Metastasis, A Case Report

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