CERVICAL SPONDYLOSIS MYELOPATHY- A REVIEW

Study Design: Review. Objectives: Cervical spondylotic myelopathy (CSM) is a significant reason of disability, especially in old-aged patients. Mindfulness and comprehension of CSM is basic to encourage early analysis and the executives. This review article delivers CSM concerning its the study of disease transmission, pathophysiology, clinical indications, imaging, treatment draws near. Methods: The authors played out a broad survey of the companion audited writing tending to the previously mentioned goals. Results: The clinical introduction and normal history of CSM is variable, switching back and forth among quiet and slippery to stepwise decay or quick neurological crumbling. For gentle CSM, preservationist choices could be utilized with cautious perception. Notwithstanding, careful intercession has demonstrated to be better for moderate than extreme CSM. The achievement of employable or traditionalist administration of CSM is multifactorial and top notch contemplates are inadequate. The ideal careful methodology is still under discussion, and can change contingent upon the quantity of levels included, area of the pathology and standard cervical sagittal arrangement. Conclusions: Early acknowledgment and treatment of CSM, before the beginning of spinal cord damage, is basic for ideal results. The objective of medical procedure is to decompress the cord with extension of the spinal canal, while reestablishing cervical lordosis, and balancing out when the danger of cervical kyphosis is high. Further high-caliber randomized clinical examinations with long haul follow up are still expected to additionally characterize the normal history and help anticipate the perfect careful methodology.

C5 palsy in the treatment of cervical spondylosis myelopathy with ossification of the posterior longitudinal ligament

Background There are many factors that affect the C5 palsy in the treatment of cervical spondylosis myelopathy (CSM) with ossification of the posterior longitudinal ligament (OPLL), but the spinal compression degrees may be an important factor in affection on it. Objective The purpose of this study was to evaluate the effect of spinal cord compression degrees on the clinical outcomes of OPLL patients which been treated by anterior and posterior surgery. Methods From May 2010 to October 2017, 145 patients cervical spondylosis myelopathy with OPLL (spinal canal narrowing by the OPLL exceeded 30%) were enrolled in this study; 76 patients received anterior cervical corpectomy and fusion surgery (ACCF), and 69 patients had posterior cervical decompression and laminoplasty procedures (PCDL). The clinical outcomes of pain relief (visual analog scale, VAS), functional disability (neck disability index, NDI) were recorded at baseline and at the final follow-up. Results There were five patients with C5 palsy in this series cases (two in ACCF and three in PCDL), and the rate is 4.1% (3.2% in ACCF and 5.2% in PCDL, P > 0.05). Five C5 palsy cases had more than 50% compressed degrees of dural sac and flattened spinal cord, and the compressed dural sac and flattened spinal cord had totally expansion after operation. There were no patients resented with CSF leakage in PCDL group, and six patients presented with CSF leakage in ACCF. The mean postoperative canal diameter were significant better than preoperative in PDL patients (P < 0.01). The average spinal sagittal and axial compressive ratio were significantly decreased from preoperative in ACR and PDL groups (P < 0.01). The mean cervical ROM values were decreased in ACR and PDL groups (P< 0.05). Conclusions Based on the results of this study, anterior and posterior surgery was effective and safe in the treatment of the OPLL patients. The complication of C5 palsy were no related in the surgery methods, but may be related the degrees of spinal cord compressed.

INTENSITAS MIELUM PADA GAMBARAN MRI SERVIKAL SEBAGAI FAKTOR PROGNOSTIK LUARAN CERVICAL SPONDYLOSIS MYELOPATHY PASCAOPERASI

MYELUM INTENSITY ON MRI CERVICAL AS PROGNOSTIC FACTORS IN CERVICAL SPONDYLOSIS MYELOPATHY PATIENTSABSTRACTIntroduction: Cervical spondylosis myelopathy (CSM) is a stenosis condition in cervical canal due to the cervical structural changes that compress the myelum, thus causing spinal medulla ischemia. Other than clinical factors, myelum intensity changes on MRI T1-weighted images (T1W1) and T2W1 might be useful to predict the pos-operative outcome.Aims: Identify prognostic factors in post-operative patients with CSM based on clinical symptoms and myelum intensity on cervical MRI.Methods: Retrospective study on CSM patients who underwent surgery in Neurosurgery Department, Cipto Mangunkusumo hospital, Jakarta, from January 2013 to December 2016. Magnetic resonance imaging data was obtained before the surgery, while clinical symptoms were assessed by Nurick scale before and 1 year after the surgery to evaluate outcome.Results: There were 50 subjects included in this study with mean age 51.98±9.64 years, majority male (76%), have moderate myelopathy (Nurick scale pre-operative ≤2), and time between onset and surgery mostly ≤1 year (80%). Most subject (88%) had improvement clinically, but mostly without hypointensity on cervical T1W1 MRI.Discussion: Myelum hypointensity in cervical MRI is associated with poor outcome in CSM post-surgery patients.Keywords: Cervical spondylosis myelopathy, MRI, myelum hypointensity, Nurick scaleABSTRAKPendahuluan: Cervical spondylosis myelopathy (CSM) merupakan suatu kondisi stenosis kanal servikal akibat adanya perubahan struktur servikal yang menyebabkan kompresi mielum, sehingga timbul iskemia medula spinalis. Selain faktor-faktor klinis, perubahan intensitas mielum pada MRI T1-weighted images (T1W1) dan T2W1 dapat dijadikan modalitas untuk memprediksi luaran pascaoperasi.Tujuan: Mengidentifikasi faktor prognosis luaran pasien CSM pascaoperasi berdasarkan gejala klinis dan intensitas mielum pada gambaran MRI servikal.Metode: Penelitian retrospektif terhadap penderita CSM yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2013 hingga Desember 2016. Dilakukan penilaian klinis dan gambaran MRI awal, serta luaran 1 tahun pascaoperasi menggunakan skor Nurick.Hasil: Terdapat 50 subjek dengan rerata usia 51,98±9,64 tahun, terutama laki-laki (76%), memiliki derajat mielopati ringan (skor Nurick preoperasi ≤2), dan jarak antara onset dengan waktu operasi ≤1 tahun (80%). Sebagian besar subjek (88%) mengalami perbaikan skor pascaoperasi yang mayoritas (95,4%) tidak didapatkan gambaran hipointesintas pada T1W1 MRI servikal.Diskusi: Hipointensitas mielum pada MRI servikal merupakan faktor prognosis luaran buruk pascaoperasi pada pasien CSM.Kata kunci: Cervical spondylosis myelopathy, hipointens, mielum, MRI, skala Nurick

Safety and Efficiency of Biomimetic Nanohydroxyapatite/Polyamide 66 Composite in Rabbits and Primary Use in Anterior Cervical Discectomy and Fusion

This study was conducted to validate the safety and efficiency of biomimetic nanohydroxyapatite/polyamide 66 (n-HA/PA66) composite in animal model (rabbit) and report its application in anterior cervical discectomy and fusion (ACDF) for 4, 12, and 24 weeks. N-HA/PA66 composite was implanted into one-side hind femur defects and the control defects were kept empty as blank controls. A combination of macroscopic and histomorphometric studies was performed up to 24 weeks postoperatively and compared with normal healing. 60 cervical spondylosis myelopathy and radiculopathy patients who were subjected to ACDF using n-HA/PA66 and PEEK cage were involved in this study with six-month minimum follow-up. Their radiographic (cage subsidence, fusion status, and segmental sagittal alignment (SSA)) and clinical (VAS and JOA scales) data before surgery and at each follow-up were recorded and compared. Nanohydroxyapatite/polyamide 66 composite is safe and effective in animal experiment and ACDF.

The Natural History and Clinical Syndromes of Degenerative Cervical Spondylosis

Cervical spondylosis is a broad term which describes the age related chronic disc degeneration, which can also affect the cervical vertebrae, the facet and other joints and their associated soft tissue supports. Evidence of spondylitic change is frequently found in many asymptomatic adults. Radiculopathy is a result of intervertebral foramina narrowing. Narrowing of the spinal canal can result in spinal cord compression, ultimately resulting in cervical spondylosis myelopathy. This review article examines the current literature in relation to the cervical spondylosis and describes the three clinical syndromes of axial neck pain, cervical radiculopathy and cervical myelopathy