scholarly journals 4278 Recovery Time is Exaggerated in Individuals with Degenerative Cervical Myelopathy Following Standing Lateral Waist Pulls

2020 ◽  
Vol 4 (s1) ◽  
pp. 101-101
Author(s):  
Timothy Boerger ◽  
Learon McGinn ◽  
Marisa Clare ◽  
Marjorie Wang ◽  
Brian D Schmit ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Repeated Measures ◽  
Recovery Time ◽  
Center Of Pressure ◽  
Significant Group ◽  
Absolute Value ◽  
Recovery Times ◽  
Study Population ◽  
Degenerative Cervical Myelopathy ◽  
Response Timing

OBJECTIVES/GOALS: The aim of this study was to quantify balance impairments in stance in individuals with degenerative cervical myelopathy (IwDCM) in response to external perturbations. IwDCM have damage to their spinal cord due to degeneration of the cervical vertebral column, but little is known about balance. METHODS/STUDY POPULATION: Recovery time following a perturbation may be an important measure of balance. Changes in recovery time were measured in 7 IwDCM (2m, 58.59±15.00y) and 6 controls without DCM (2m, 56.91±11.04y) as they stood on an instrumented treadmill and received cued (predictable) and uncued (unpredictable) lateral pulls to the waist at 12% (high) and 6% (low) pull magnitudes. Individuals stood with feet together, shoulder width, and wide. Recovery time was defined as the time following pull onset when the absolute value of the center of pressure velocity returned to <1x baseline standard deviation. Repeated measures ANOVA was performed on recovery time. RESULTS/ANTICIPATED RESULTS: We anticipate that feet together standing, unpredictable, higher magnitude perturbations will be most challenging evidenced by longer recovery times. For waist pull recovery time, there was a trend for a Group x Predictability x Magnitude x Stance Width interaction (p = 0.1) which we anticipate being greater with additional participants. There were significant Group x Predictability x Stance Width (p = 0.01) and Group x Magnitude x Predictability (p = 0.01) interactions. IwDCM had exaggerated recovery times in narrow and wide stances with unpredictable pulls. IwDCM recovered more slowly in response to unpredictable higher magnitude pulls. DISCUSSION/SIGNIFICANCE OF IMPACT: Balance responses in IwDCM are most impaired in narrow stances and when perturbations are unpredictable. Rehabilitation should focus on shortening latency of response timing and increasing power utilization during balance response to promote quicker recovery.

scholarly journals Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery?

2019 ◽  
Vol 9 (1) ◽  
pp. 62 ◽  
Author(s):  
Oliver Gembruch ◽  
Ramazan Jabbarli ◽  
Ali Rashidi ◽  
Mehdi Chihi ◽  
Nicolai El Hindy ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cervical Myelopathy ◽  
Age Groups ◽  
Age Group ◽  
Group Effect ◽  
Significant Group Effect ◽  
Aged Patients ◽  
Significant Group ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.

scholarly journals Clinical outcomes of epidural and intradural decompression for treatment of degenerative cervical myelopathy

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092958
Author(s):  
Genlong Jiao ◽  
Zhizhong Li ◽  
Pan Zhou ◽  
Jinpei Yang ◽  
Xueshi Li
Keyword(s):  
Clinical Outcomes ◽  
Cervical Myelopathy ◽  
Recovery Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Control Group ◽  
Study Group ◽  
Pia Mater ◽  
Improvement Rate ◽  
Degenerative Cervical Myelopathy

Objective This study was performed to examine the clinical outcomes of epidural and intradural decompression for degenerative cervical myelopathy. Methods The data for 13 patients who underwent epidural and intradural decompression for treatment of degenerative cervical myelopathy (study group) and 20 patients who underwent only cervical laminoplasty, fusion, and epidural decompression (historical control group) were retrospectively reviewed. The preoperative and postoperative neurological status was evaluated using the Japanese Orthopaedic Association (JOA) score. Results All patients’ neurological symptoms were significantly improved at the final follow-up. In the study group, the patients’ mean preoperative JOA score was 8.07 ± 1.80, and the final score improved by 70.88% ± 21.18%. The blood loss and operation time were significantly greater in the study group than control group. The recovery time was shorter in the study group than control group. The improvement rate was not significantly different between the two groups. Conclusions A pia mater incision with separation of the arachnoid adhesion can significantly improve the cerebrospinal fluid flow and spinal blood flow in degenerative cervical myelopathy. Arachnoid adhesion can lead to intradural spinal scar compression. The surgical intervention described herein can achieve satisfactory neurological outcomes and shorten the recovery time.

scholarly journals Spine Treatment Appraisal Report (STAR): Does Riluzole Improve Outcomes in Patients Undergoing Decompression Surgery for Degenerative Cervical Myelopathy?

2021 ◽  
pp. 219256822199740
Author(s):  
Joseph R. Dettori
Keyword(s):  
Cervical Myelopathy ◽  
Decompressive Surgery ◽  
Decompression Surgery ◽  
Phase 3 ◽  
Double Blind ◽  
Safety And Efficacy ◽  
Double Blind Placebo ◽  
Degenerative Cervical Myelopathy

Fehlings MG, Badhiwala JH, Ahn H, et al. Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol. 2020.

scholarly journals Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms

2021 ◽  
Vol 10 (6) ◽  
pp. 1214
Author(s):  
Ji Tu ◽  
Jose Vargas Castillo ◽  
Abhirup Das ◽  
Ashish D. Diwan
Keyword(s):  
Cervical Myelopathy ◽  
Molecular Mechanisms ◽  
Current Knowledge ◽  
Imaging Techniques ◽  
Disease Process ◽  
Classification Systems ◽  
Molecular Features ◽  
Formidable Challenge ◽  
Long Term Treatment ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.

“Going Backward”: Effects of age and fatigue on posterior-directed falls in Parkinson disease

2021 ◽  
pp. 1-9
Author(s):  
Evan V. Papa ◽  
Rita M. Patterson ◽  
Nicoleta Bugnariu
Keyword(s):  
Postural Control ◽  
Parkinson Disease ◽  
Repeated Measures ◽  
Center Of Pressure ◽  
Angular Displacement ◽  
Reaction Times ◽  
Older Individuals ◽  
Peak Knee ◽  
Significant Difference ◽  
Fatiguing Exercise

BACKGROUND: Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue. OBJECTIVE: We sought to investigate the influences of performance fatigue and age on postural control in persons with PD. METHODS: Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables. RESULTS: After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued. CONCLUSIONS: The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.

scholarly journals Development of a validated search filter for Ovid Embase for degenerative cervical myelopathy

2021 ◽  
Author(s):  
Maaz A. Khan ◽  
Oliver M. Mowforth ◽  
Isla Kuhn ◽  
Mark R. N. Kotter ◽  
Benjamin M. Davies
Keyword(s):  
Cervical Myelopathy ◽  
Search Filter ◽  
Degenerative Cervical Myelopathy

scholarly journals Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

2021 ◽  
pp. 219256822199830
Author(s):  
Mohamed Kamal Mesregah ◽  
Blake Formanek ◽  
John C. Liu ◽  
Zorica Buser ◽  
Jeffrey C. Wang
Keyword(s):  
Propensity Score ◽  
Cervical Myelopathy ◽  
Perioperative Complications ◽  
International Classification Of Diseases ◽  
Significance Level ◽  
Chi Squared ◽  
Retrospective Comparative Study ◽  
Posterior Laminectomy ◽  
Degenerative Cervical Myelopathy ◽  
New Onset

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons

2021 ◽  
Vol 87 ◽  
pp. 84-88
Author(s):  
Benjamin M. Davies ◽  
Jibin J. Francis ◽  
Max B. Butler ◽  
Oliver Mowforth ◽  
Edward Goacher ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
International Survey ◽  
Surgical Practice ◽  
Multi Level ◽  
Degenerative Cervical Myelopathy

Predialytic versus Intradialytic Nutrition: A Study to Assess Effects on Intradialytic Blood Pressure, Dialysis Adequacy, and Urea Removal

2021 ◽  
pp. 1-6
Author(s):  
Namrata S. Rao ◽  
Abhilash Chandra ◽  
Sai Saran ◽  
Manish Raj Kulshreshta ◽  
Prabhakar Mishra ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Dialysis Adequacy ◽  
Fasting Period ◽  
Significant Group ◽  
Protein Requirements ◽  
Dialysis Vintage ◽  
Oral Nutritional Supplements ◽  
Blood Pressures ◽  
Group 2 ◽  
Group 1

<b><i>Background:</i></b> Provision of oral protein in hemodialysis (HD) is desirable due to improved compliance to protein requirements and better nutritional status, but the risks of hypotension and underdialysis need to be considered. This study compared 2 different timings for administering oral nutritional supplements (ONS), predialysis and mid-dialysis, with respect to hemodynamics, dialysis adequacy, urea removal, and tolerability. <b><i>Methods:</i></b> This single-center, prospective crossover study analyzed 72 stable patients with ESRD on twice a week maintenance HD with a mean age of 38.7 (±11.2) years and a dialysis vintage of 28.2 (±13.1) months. In the first week, all the patients received ONS (450 kcal energy, 20 g protein) 1 h prior to start of dialysis (group 1) and in the next week, the supplement was administered after 2 h of start of dialysis (group 2), with a predialysis fasting period of at least 3 h in both groups. Blood pressures, serum, and spent dialysate samples were collected and nausea occurrence was noted by severity. <b><i>Results:</i></b> Predialytic intake (group 1) was associated with higher predialysis and 1st hour blood urea, dialysis adequacy, and urea removal than group 2. Both groups achieved mean Kt/V &#x3e; 1.2, and the occurrence of symptomatic hypotensive episodes and nausea was not significantly different between the groups. On repeated measures ANOVA, changes in blood urea over time showed significant group effect. <b><i>Conclusions:</i></b> Predialytic supplementation was associated with better dialysis adequacy and urea removal than intradialytic supplementation. However, both timings were equally tolerated and not associated with underdialysis.

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