MyMedR

Fulltext Management of mild degenerative cervical myelopathy and asymptomatic spinal cord compression: an international survey

Brannigan JFM, Davies BM, Mowforth OD, Yurac R, Kumar V, Dejaegher J, et al.

Spinal Cord, 2024 Feb;62(2):51-58.

PMID: 38129661 DOI: 10.1038/s41393-023-00945-8

STUDY DESIGN: Cross-sectional survey.

OBJECTIVE: Currently there is limited evidence and guidance on the management of mild degenerative cervical myelopathy (DCM) and asymptomatic spinal cord compression (ASCC). Anecdotal evidence suggest variance in clinical practice. The objectives of this study were to assess current practice and to quantify the variability in clinical practice.

METHODS: Spinal surgeons and some additional health professionals completed a web-based survey distributed by email to members of AO Spine and the Cervical Spine Research Society (CSRS) North American Society. Questions captured experience with DCM, frequency of DCM patient encounters, and standard of practice in the assessment of DCM. Further questions assessed the definition and management of mild DCM, and the management of ASCC.

RESULTS: A total of 699 respondents, mostly surgeons, completed the survey. Every world region was represented in the responses. Half (50.1%, n = 359) had greater than 10 years of professional experience with DCM. For mild DCM, standardised follow-up for non-operative patients was reported by 488 respondents (69.5%). Follow-up included a heterogeneous mix of investigations, most often at 6-month intervals (32.9%, n = 158). There was some inconsistency regarding which clinical features would cause a surgeon to counsel a patient towards surgery. Practice for ASCC aligned closely with mild DCM. Finally, there were some contradictory definitions of mild DCM provided in the form of free text.

CONCLUSIONS: Professionals typically offer outpatient follow up for patients with mild DCM and/or asymptomatic ASCC. However, what this constitutes varies widely. Further research is needed to define best practice and support patient care.

Matched MeSH terms: Cervical Vertebrae/surgery

Stability of cervical spine after one-level corpectomy using different numbers of screws and plate systems

Rosli R, Abdul Kadir MR, Kamarul T

Proc Inst Mech Eng H, 2014 Apr;228(4):342-9.

PMID: 24622982 DOI: 10.1177/0954411914527074

Anterior corpectomy and reconstruction using a plate with locking screws are standard procedures for the treatment of cervical spondylotic myelopathy. Although adding more screws to the construct will normally result in improved fixation stability, several issues need to be considered. Past reports have suggested that increasing the number of screws can result in the increase in spinal rigidity, decreased spine mobility, loss of bone and, possibly, screw loosening. In order to overcome this, options to have constrained, semi-constrained or hybrid screw and plate systems were later introduced. The purpose of this study is to compare the stability achieved by four and two screws using different plate systems after one-level corpectomy with placement of cage. A three-dimensional finite-element model of an intact C1-C7 segment was developed from computer tomography data sets, including the cortical bone, soft tissue and simulated corpectomy fusion at C4-C5. A spinal cage and an anterior cervical plate with different numbers of screws and plate systems were constructed to a fit one-level corpectomy of C5. Moment load of 1.0 N m was applied to the superior surface of C1, with C7 was fixed in all degrees of freedom. The kinematic stability of a two-screw plate was found to be statistically equivalent to a four-screw plate for one-level corpectomy. Thus, it can be a better option of fusion and infers comparable stability after one-level anterior cervical corpectomy, instead of a four-screw plate.

Matched MeSH terms: Cervical Vertebrae/surgery*

Fulltext Unilateral visual loss after spine surgery in the prone position for extradural haematoma in a healthy young man

Ooi EI, Ahem A, Zahidin AZ, Bastion ML

BMJ Case Rep, 2013;2013.

PMID: 24334521 DOI: 10.1136/bcr-2013-200632

This case reports a patient who developed central retinal artery occlusion following spinal surgery in the prone position. When placed in this position, especially as a result of malposition of the head, the patient may develop external compression of the eye which leads to central retinal artery occlusion. Therefore, a special precaution must be given for adequate eye protection during prolonged prone-positioned spine surgery.

Matched MeSH terms: Cervical Vertebrae/surgery

Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements

Yusof MI, Shamsi SS

Surg Radiol Anat, 2012 Apr;34(3):203-7.

PMID: 21947622 DOI: 10.1007/s00276-011-0869-8

Cervical translaminar screw fixation has been shown to be safe, efficient and provides alternative for cervical fixation. However, its use in the Asian population should be considered cautiously because the cervical lamina diameter may not be adequate to accommodate the standard lamina screw size. We studied the average transverse lamina diameter of the cervical spine in the Malaysian population to evaluate the feasibility and safety of lamina screw fixation in this population.

Matched MeSH terms: Cervical Vertebrae/surgery*

Predicted cervical canal enlargement and effective cord decompression following expansive laminoplasty using cervical magnetic resonance imaging

Yusof MI, Hassan E, Abdullah S

Surg Radiol Anat, 2011 Mar;33(2):109-15.

PMID: 20658232 DOI: 10.1007/s00276-010-0704-7

Posterior translation of the spinal cord occurs passively following laminoplasty with the presence lordotic spine and availability of a space for the spinal cord to shift. This study is to predict the distance of posterior spinal cord migration after expansive laminoplasty at different cervical levels based on measurement of posterior translation of the spinal cord in normal cervical morphometry.

Matched MeSH terms: Cervical Vertebrae/surgery*

Fulltext Cervical cord compression presenting with sciatica-like leg pain

Chan CK, Lee HY, Choi WC, Cho JY, Lee SH

Eur Spine J, 2011 Jul;20 Suppl 2:S217-21.

PMID: 20938789 DOI: 10.1007/s00586-010-1585-5

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed in two cases of cervical cord compressions, which presented with sciatica-like leg pain. There was multi-level cervical spondylosis with cord compression in the first patient and the second patient had two levels of cervical disc herniation with cord compression. In both cases, there were co-existing lumbar lesions, which could be responsible for the presentation of the leg pain. Cervical blocks were diagnostic in identifying the level responsible for the leg pain and it was confirmed so after cervical decompressive surgery in both cases, which brought significant pain relief. Funicular leg pain is a rare presentation of cervical cord compression. It is a referred pain due to the irritation of the ascending spinothalamic tract. Cervical blocks were successful in identifying the cause of funicular pain in our cases and this may pave the way for further studies to establish the role of cervical blocks as a diagnostic tool for funicular pain caused by cord compression.

Matched MeSH terms: Cervical Vertebrae/surgery

Fulltext Delayed decompression of chronic C1C2 subluxation in a pediatric patient with tetraplegia--is recovery possible?

Razif M, Lim HH

Med J Malaysia, 2001 Jun;56 Suppl C:76-9.

PMID: 11814256

A 2 year-old Malay girl was admitted to our institution with a chesty cough and breathlessness but later found to have a chronic C1/C2 subluxation for one and half year with tetraplegia. Her cervical cord was decompressed and occipito-cervical fusion performed. Her neurological status improved significantly post-operatively and is able to care for her personal hygiene. The authors believe that the ability of the cervical cord to recover in the paediatric age group is remarkable that surgical option should be considered even when all seen lost. We believe that this is the first report in the literature to support this potential.

Matched MeSH terms: Cervical Vertebrae/surgery*

Backstabbing swordfish: a rare cause of traumatic hemiparesis

Sriram PR, Tsin Jien TC, Sellamuthu P

J Neurosurg Spine, 2017 Aug;27(2):158-160.

PMID: 28524750 DOI: 10.3171/2016.12.SPINE16586

Swordfish attacks on humans are uncommon, with only a few case reports available in the current literature. The authors report the first known case of a penetrating spinal injury from a swordfish, in which the patient presented with a small stab wound and hemiparesis. The presentation of a fisherman with hemiparesis and a harmless-looking stab wound must alert clinicians to the possibility of penetrating swordfish injuries to the spine.

Matched MeSH terms: Cervical Vertebrae/surgery

Fulltext C1-C2 fusion with absence of C1 posterior arch and presence of C2 high-riding vertebral artery: Is it possible?

Wong TS, Abdul Rashid ML, Hasan MS, Chiu CK, Chan CYW, Kwan MK

J Orthop Surg (Hong Kong), 2019 4 9;27(2):2309499019840763.

PMID: 30955474 DOI: 10.1177/2309499019840763

The presence of anatomical anomalies such as absence of C1 posterior arch and presence of C2 high-riding vertebral artery may not allow a conventional C1-C2 fusion, and this patient will require occipitocervical fusion. A 62-year-old lady presented with cervical myelopathy. CT scan demonstrated an os odontoideum with C1-C2 dislocation. The posterior arch of atlas on right C1 vertebra was absent, and there was high-riding vertebral artery on left C2. MRI revealed severe cord compression with cord oedema. The chronic atlantoaxial dislocation was reduced successfully with skeletal traction. Hybrid C1-C2 fusion augmented with autogenous local bone graft with corticocancellous iliac crest bone graft was performed to avoid an unnecessary occipitocervical fusion. She was stable throughout surgery and discharged 6 days later. CT scan 6 months post-operation showed a solid posterior fusion mass. Hybrid C1-C2 fusion can be performed to avoid occipitocervical fusion despite presence of abnormal anatomy at C1 and C2 vertebrae.

Matched MeSH terms: Cervical Vertebrae/surgery*

The effect of excision of the posterior arch of C1 on C1/C2 fusion using transarticular screws

Chang KC, Samartzis D, Fuego SM, Dhatt SS, Wong YW, Cheung WY, et al.

Bone Joint J, 2013 Jul;95-B(7):972-6.

PMID: 23814252 DOI: 10.1302/0301-620X.95B7.30598

Transarticular screw fixation with autograft is an established procedure for the surgical treatment of atlantoaxial instability. Removal of the posterior arch of C1 may affect the rate of fusion. This study assessed the rate of atlantoaxial fusion using transarticular screws with or without removal of the posterior arch of C1. We reviewed 30 consecutive patients who underwent atlantoaxial fusion with a minimum follow-up of two years. In 25 patients (group A) the posterior arch of C1 was not excised (group A) and in five it was (group B). Fusion was assessed on static and dynamic radiographs. In selected patients CT imaging was also used to assess fusion and the position of the screws. There were 15 men and 15 women with a mean age of 51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6). Stable union with a solid fusion or a stable fibrous union was achieved in 29 patients (97%). In Group A, 20 patients (80%) achieved a solid fusion, four (16%) a stable fibrous union and one (4%) a nonunion. In Group B, stable union was achieved in all patients, three having a solid fusion and two a stable fibrous union. There was no statistically significant difference between the status of fusion in the two groups. Complications were noted in 12 patients (40%); these were mainly related to the screws, and included malpositioning and breakage. The presence of an intact or removed posterior arch of C1 did not affect the rate of fusion in patients with atlantoaxial instability undergoing C1/C2 fusion using transarticular screws and autograft.

Matched MeSH terms: Cervical Vertebrae/surgery*

Endoscopic, endonasal decompression of spinal stenosis with myelopathy secondary to cranio-vertebral tuberculosis: two cases

Puraviappan P, Tang IP, Yong DJ, Prepageran N, Carrau RL, Kassam AB

J Laryngol Otol, 2010 Jul;124(7):816-9.

PMID: 20003599 DOI: 10.1017/S0022215109992271

Tuberculosis can cause extensive osseo-ligamentous destruction at the cranio-vertebral junction, leading to atlanto-axial instability and compression of vital cervico-medullary centres. This may manifest as quadriparesis, bulbar dysfunction and respiratory insufficiency.

Matched MeSH terms: Cervical Vertebrae/surgery

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