scholarly journals The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

2021 ◽  
Vol 10 (16) ◽  
pp. 3653
Author(s):  
Xiaoyu Yang ◽  
Aref-Ali Gharooni ◽  
Rana S. Dhillon ◽  
Edward Goacher ◽  
Edward W. Dyson ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Clinical Effectiveness ◽  
Posterior Longitudinal Ligament ◽  
Surgical Approaches ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Multi Level ◽  
Degenerative Cervical Myelopathy ◽  
Surgical Treatments ◽  
Retrospective Reporting

Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion. Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.

scholarly journals Surgical decision-making for ossification of the posterior longitudinal ligament versus other types of degenerative cervical myelopathy: anterior versus posterior approaches

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Suzanna Sum Sum Kwok ◽  
Jason Pui Yin Cheung
Keyword(s):  
Decision Making ◽  
Cervical Myelopathy ◽  
Anterior Approach ◽  
Posterior Approach ◽  
Posterior Longitudinal Ligament ◽  
Current Evidence ◽  
Cervical Kyphosis ◽  
Co Morbidity ◽  
Multi Level ◽  
Degenerative Cervical Myelopathy

Abstract Background The debate between anterior or posterior approach for pathologies such as cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) have drawn heated debate but are still inconclusive. Main body of the abstract A narrative review was performed specifically to study the differences pertaining to OPLL and other causes of degenerative cervical myelopathy (DCM). Current evidence suggests that anterior approach is preferred for K-line (−) OPLL, K-line (+) with canal occupying ratio > 60% and DCM with pre-existing cervical kyphosis. Posterior approach is preferred for K-line (+) OPLL with canal-occupying ratio < 50–60%, and multi-level CSM. No particular advantage for either approach was observed for DCM in a lordotic cervical spine. Anterior approach is generally associated with more complications and thus needs to be weighed carefully during decision-making. The evidence is not convincing for comparing single versus multi-level involvement, and the role of patients' co-morbidity status, pre-existing osteoporosis and co-existent spinal pathologies in influencing patient outcome and surgical options. This should be a platform for future research directives. Conclusion From this review, evidence is still inconclusive but there are some factors to consider, and DCM and OPLL should be considered separately for decision-making. Anterior approach is considered for pre-existing cervical kyphosis in DCM, for K-line (−) regardless of canal-occupying ratio, and K-line (+) and canal-occupying ratio > 60% for OPLL patients. Posterior approach is considered for patients with multi-level pathology for DCM, and K-line (+) and canal-occupying ratio < 50–60% for OPLL.

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

scholarly journals The Natural History of Degenerative Cervical Myelopathy and the Rate of Hospitalization Following Spinal Cord Injury: An Updated Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 28S-34S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
Spyridon Karadimas ◽  
Jefferson R. Wilson ◽  
Paul M. Arnold ◽  
Shekar Kurpad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Natural History ◽  
Cervical Myelopathy ◽  
Cochrane Collaboration ◽  
Level Of Evidence ◽  
Cord Injury ◽  
History Of ◽  
Degenerative Cervical Myelopathy

Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low.

scholarly journals Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database

2021 ◽  
pp. 219256822110638
Author(s):  
Shingo Morishita ◽  
Toshitaka Yoshii ◽  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
Masato Yuasa ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Cervical Spondylotic Myelopathy ◽  
Perioperative Complications ◽  
Posterior Longitudinal Ligament ◽  
Medical Costs ◽  
Complication Rates ◽  
Systemic Complications ◽  
Hospitalization Costs ◽  
Degenerative Cervical Myelopathy ◽  
Inpatient Database

Study Design Retrospective cohort study. Objectives Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. Methods This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. Results This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. Conclusions More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.

Cervical spinal disease

2019 ◽  
pp. 697-710
Author(s):  
Navin Furtado ◽  
Georgios Tsermoulas ◽  
Adikarige Haritha Dulanka Silva
Keyword(s):  
Cervical Spine ◽  
Natural History ◽  
Neck Pain ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Posterior Longitudinal Ligament ◽  
Surgical Approaches ◽  
Systemic Diseases ◽  
Spinal Disease ◽  
Disc Disease ◽  
Degenerative Cervical Myelopathy

Degenerative cervical spinal disease refers to neck pain, myelopathy, and/or radiculopathy. It is a common problem with increased prevalence above the age of 55 years. Understanding the natural history and pathophysiology is crucial in selecting patients for surgery. The degenerative pathological processes that can occur in the cervical spine include degenerative disc disease, degenerative cervical myelopathy, ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF). There are also systemic diseases affecting the cervical spine and these include rheumatoid disease, sero-negative spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). This section describes the pathology of cervical spinal disease, the clinical management, surgical approaches, and controversies in the field.

scholarly journals DEGENERATIVE CERVICAL MYELOPATHY: A REVIEW OF CURRENT CONCEPTS

2020 ◽  
Vol 19 (4) ◽  
pp. 302-307
Author(s):  
EDUARDO MOREIRA PINTO ◽  
ARTUR TEIXEIRA ◽  
RICARDO FRADA ◽  
PEDRO ATILANO ◽  
FILIPA OLIVEIRA ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Cervical Spinal Cord ◽  
Treatment Options ◽  
Functional Decline ◽  
Clinical Syndrome ◽  
Loss Of Function ◽  
Level Of Evidence ◽  
Imaging Evaluation ◽  
Degenerative Cervical Myelopathy

ABSTRACT Herbert von Luschka, a German anatomist, was the first to describe the developmental changes in the anatomical structures of the cervical spine. Degenerative cervical myelopathy (DCM) represents a collection of pathological entities that cause compression of the cervical spinal cord, resulting in a clinical syndrome typified by spasticity, hyperreflexia, pathologic reflexes, finger/hand clumsiness, gait disturbance and sphincter dysfunction. In the cervical spine, certain patients are more likely to have myelopathy due to a congenitally narrowed cervical spine canal. Degenerative changes are more common at C5 and C6 or C6 and C7 due to the increased motion at these levels. Additional contributors to canal narrowing are infolding of the ligamentum flavum, olisthesis, osteophytes, and facet hypertrophy. Myelopathy will develop in approximately 100% of patients with canal stenosis greater than 60% (less than 6 mm sagittal disc cord space). Classically it has an insidious onset, progressing in a stepwise manner with functional decline. Without treatment, patients may progress toward significant paralysis and loss of function. Treatment requires surgery with either anterior or posterior decompression of the area of narrowing, and probable fusion. Factors of a poor prognosis include symptoms lasting for more than 18 months, increased range of motion in the cervical spine, and female gender. In this study, we give an overview of the state-of-the-art in DCM, with a focus on the pathophysiology, clinical presentation, differential diagnosis, imaging evaluation, natural history, treatment options and complications. Level of evidence III; Review article.

Prevalence of Ossification of Posterior Longitudinal Ligament in Patients With Degenerative Cervical Myelopathy

Spine ◽  
2020 ◽  
Vol 45 (19) ◽  
pp. 1320-1328
Author(s):  
Xinyuan Liao ◽  
Zhenxiong Jin ◽  
Lei Shi ◽  
Yin Zhao ◽  
Shengyuan Zhou ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Posterior Longitudinal Ligament ◽  
Degenerative Cervical Myelopathy
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