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Objectives: Cervical spinal canal-expanding laminoplasty has been recognized as an alternative to cervical laminectomy, especially in multilevel cervical myelopathy due to spinal stenosis. This study aimed to determine the effects of En-block laminoplasty on cervical sagittal balance, cervical spine biomechanics and whether it is sufficient to preserve cervical canal diameter and lordosis and whether it causes additional lordosis or kyphosis in cases of cervical narrow spinal canal. Methods: Thirty-eight cervical narrow canal patients operated on between 2008 and 2020 were retrospectively evaluated and the results of 24 laminoplasty patients were evaluated. Spinal tomography results for the evaluation of canal diameter changes and X-ray results for cervical sagittal balance evaluation were compared with each other in the early postoperative period and 3 years later. For cervical lordosis assessment, Cobb and C2-C7sagital vertical axis measurements were performed using the PACS system. Results: Fifteen patients were male and 9 were female. The mean age was 65.55±11.56 years (min-max: 58-84) and the mean follow-up period was three years. Two patients had one level stenosis, 4 had two levels, 7 had three levels, and 11 had four or more levels. Radiculopathy was present in 17 patients (71.8%) and myelopathy in 7 patients (29.1%). There was no statistically significant difference in the frequency of myelopathy/radiculopathy between genders. When all distances were considered, no statistical difference was observed in the early postoperative period (median ten days) and late postoperative period (median 3 years) in terms of canal diameters. No measurement value could be obtained for any level diagnosed as restenosis or requiring reoperation. Loss of lordosis was measured in only one patient. Otherwise, lordosis was preserved in all cases at late conversion. Conclusions: The results of our study showed that en-block laminoplasty after the cervical narrow spinal canal was sufficient to maintain the cervical canal diameter in the long term with appropriate patient and surgical technique. [ABSTRACT FROM AUTHOR]

Abstract Objective Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF. Methods 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG). Results After PSM, 84 patients were included in the study and followed for 24–30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P 0.05). Conclusion Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.

Objective: Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF. Methods: 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG). Results: After PSM, 84 patients were included in the study and followed for 24–30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05). Conclusion: Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical outcomes of patients with cervical spondylotic myelopathy (CSM) operated using the en-bloc laminoplasty technique and the effects of surgical timing on clinical outcomes. Materials and Methods: This study analyzed the preoperative and postoperative outcomes of 32 patients who underwent en-bloc cervical laminoplasty for CSM. The effect of preoperative symptom duration on postoperative clinical outcomes and the clinical outcomes of enbloc cervical laminoplasty were evaluated. The modified Japanese Orthopedic Association (mJOA) score and Nurick scale were used for preoperative and postoperative functional and neurological evaluation. Results: The mean age of the patients was 66.3 years. Twenty-one patients were male (65.6%) and 11 were female (34.4%), and the mean follow-up period was 34.7 months. Seven of eight patients with mJOA scores of 15 and above had complete recovery and one had partial benefit. Of the 10 patients with mJOA scores between 12 and 15, 7 improved above 15 points and 3 showed partial improvement. Of the 14 patients with a score below 12, 10 had improved to the 12-15 range, whereas 3 had remained unchanged. Deterioration was observed in one patient. Conclusion: Low mJOA scores, high Nurick grade, and long preoperative symptom duration negatively affected surgical treatment results. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to demonstrate the impact of lumbar spinal stenosis (LSS) on LBP after cervical laminoplasty for cervical spinal stenosis by analyzing the clinical characteristics and surgical outcomes. Methods: This retrospective cohort study analyzed 56 consecutive patients with cervical spinal stenosis who underwent cervical laminoplasty. Data on age, sex, Japanese Orthopaedic Association (JOA) scores, JOA Back Pain Evaluation Questionnaire (BPEQ), and visual analog scale (VAS) were collected. The patients with VAS for LBP ≥ 30 or more were included and divided into two groups: without LSS [LSS (−)]or with LSS [LSS (+)]. Preoperative clinical characteristics and postoperative changes were compared between the groups. Results: Preoperative VAS for LBP were 50.7 ± 16.2 mm and 59.8 ± 19.5 mm in the LSS (+) and LSS (−), respectively (p = 0.09). Patients in the LSS (−) were younger (57.6 ± 11.2 vs. 70.7 ± 8.6, p < 0.001) and showed significantly milder preoperative lumbar symptoms in terms of JOA and BPEQ. Patients in the LSS (−) group showed more postoperative changes in low back pain (18.3 ± 26.4 vs. − 8.3 ± 37.6, p = 0.005) and lumbar function (10.8 ± 25.7 vs. − 2.0 ± 22.5, p = 0.04) at BPEQ, and higher recovery in terms of VAS of LBP (23.0 ± 23.8 mm vs. 5.3 ± 25.9 mm, p = 0.008) and buttocks and low limbs (12.5 ± 35.0 mm vs. − 4.3 ± 24.4 mm, p = 0.029). Nine patients in the LSS (+) group underwent lumbar surgery at 12.8 ± 8.5 months after cervical laminoplasty. Conclusion: LBP improved after cervical laminoplasty in patients without lumbar stenosis. [ABSTRACT FROM AUTHOR]

Aim: In this intriguing review, the authors dive into the complex world of atlas stenosis and its clinical impact on cervical myelopathy. The authors shed light on the origins of atlas stenosis, highlighting how congenital abnormalities of the atlas are a result of failures in embryological development. Furthermore, diagnosis and treatment methods are described. Materials and method: Utilizing a detailed search of the literature in the PubMed database, the authors have compiled a comprehensive analysis of the anatomical and biological basis of this condition. After applying the exclusion criteria, 25 papers were deemed appropriate for the present review. Results: With the help of computed tomography (CT) and magnetic resonance imaging (MRI) scans, diagnosis becomes possible, but the authors emphasize the importance of using special tests for a more accurate assessment. When it comes to treatment, surgical decompression with laminectomy or laminoplasty is the suggested approach. This highlights the severity of atlas stenosis and the need for intervention to alleviate the symptoms and prevent further neurological damage. What sets this review apart is its focus on the clinical profile of atlas stenosis. The authors discuss how the obstruction of cerebrospinal fluid flow can lead to neurological disorders and headaches. This sheds light on the broader impact this condition can have on patients' lives beyond simply the anatomical implications. Conclusion: In the conclusion, the authors emphasize the susceptibility of the spinal cord to injuries even with mild mechanical pressure or instability due to aging in patients with atlas stenosis. Additionally, the instabilities caused by anatomical abnormalities of the atlas further highlight the importance of considering atlas stenosis in cases of cervical trauma. Overall, this review provides a fascinating insight into the connection between atlas stenosis and cervical myelopathy. By exploring the anatomical, biological, diagnostic, and treatment aspects of this condition, the authors have contributed to the understanding of this complex and often overlooked topic. [ABSTRACT FROM AUTHOR]

The diagnosis and treatment of tandem stenosis have been widely discussed. However, studies on concurrent cervical and thoracic spinal stenosis are rare in the literature. This study was aimed to investigate the risk factors for thoracic spinal stenosis (TSS) in patients with cervical spinal stenosis (CSS). This retrospective cohort study assessed the risk factors for TSS in 162 patients who were diagnosed with CSS. Patients were divided into TSS (n = 45) and non-TSS (n = 117) groups. We retrospectively analyzed clinical characteristics and radiographic parameters including age, gender, body mass index, ossification of the cervical posterior longitudinal ligament (OPLLc), hypertrophy of cervical ligamentum flavum (HLFc), cervical stenosis segments, and cervical sagittal parameters. Cervical sagittal parameters were measured on T2-weighted magnetic resonance imaging including C2-7 Cobb angle, cervical tilt, T1 slope, thoracic inlet angle (TIA), C2–C7 sagittal vertical axis (C2–C7), and cervical curvature. Two groups showed significant differences in ossification of the cervical posterior longitudinal ligament, HLFc, cervical stenosis segments, and TIA. The receiver operating characteristic curves demonstrated that the optimal threshold for TIA was 68.25. In multivariate logistic regression analysis, OPLLc (odds ratio [OR] = 4.403, 95% confidence interval [CI] = 1.782–10.880, P = 0.001), HLFc (OR = 4.849, 95% CI = 1.995–11.782, P < 0.001), and TIA >68.25 degrees (OR = 2.555, 95% CI = 1.044–6.251, P = 0.040) were independent risk factors for TSS. Moreover, the multiindex receiver operating characteristic curve demonstrated that the area under the curve for predicted probability was 0.799 (P < 0.001). Routine thoracic magnetic resonance imaging assessment is strongly recommended in CSS patients with OPLLc, HLFc, and enlarged TIA to screen for neglected but vital thoracic disease. [ABSTRACT FROM AUTHOR]

Objective This study aimed to comprehensively assess the prevalence and distribution of degenerative cervical and thoracic diseases with compression of the spinal cord, such as disc herniation (TDH) or hypertrophied ligamentum flavum causing stenosis, by reviewing the literature. Methods We searched PubMed/MEDLINE to identify articles on the prevalence of degenerative diseases with compression of the spinal cord in the cervical and thoracic spine. The levels of evidence were classified according to the NASS 2005 method. We selected articles containing information on the prevalence of degenerative cervical and thoracic diseases. Results We identified 358 articles. Thirty-eight met our criteria, with evidence ranging from levels I to V. The prevalence of asymptomatic spinal cord compression lesions was found to be relatively high in elderly people with underlying conditions. Non-traumatic spinal cord injuries are caused by various degenerative diseases involving spinal cord compression, such as cervical myelopathy, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum, and are observed in more than 50% of patients with lesions in Japan and the United States, more than 30% in Europe, and more than 20% in Australia. Regarding thoracic lesions, a prevalence of 5% to 10% has been reported for various spinal cord compression lesions such as herniated disc, ossification of the posterior longitudinal ligament, and ossification of the ligamentum flavum. Conclusion Spinal cord compressive lesions appear not to be rare in the cervical and thoracic spine. The radiographic findings of various stenotic lesions must be well understood and correlated with clinical symptoms before treatment decisions.

Elevated protein levels in cerebrospinal fluid (CSF) can occur in various pathologies and are sometimes difficult to interpret. We report a 62-year-old male patient with subacute neurological deterioration, progressive tetraparesis, and cytoalbumin dissociation in the lumbar CSF. The patient had a pre-existing cervical spinal stenosis with mild tetraparesis. Based on the initial cytoalbumin dissociation (protein 938 mg/dL, 4 leucocytes/µL), Guillain–Barré syndrome was initially considered. For further diagnosis, a CSF sample was taken from a pre-existing ventriculoperitoneal shunt, which showed a normal protein and cell count considering the patient's age (protein 70 mg/dL, 1 leucocyte/µL). In conclusion, we suggest that intermediate aggravation of tetraparesis was due to pneumonia with septic constellation, and the cytoalbumin dissociation was interpreted as Froin's syndrome (FS) due to spinal stenosis. In this unique case, we were able to prove the -often suspected- case of FS by parallel analysis of ventriculoperitoneal shunt and lumbar CSF. The triad of xanthochromia, high protein levels, and marked coagulation was first described by Georges Froin and occurs in various processes leading to severe spinal stenosis. The altered composition of lumbar CSF might be due to impaired CSF circulation; however, the exact mechanisms of this phenomenon require further investigation. [ABSTRACT FROM AUTHOR]

Background: There is sparse literature on the technique of single-stage anterior discectomy fusion and posterior decompression and flavectomy using the biportal endoscopic technique. Methods: Single-stage anterior discectomy fusion and posterior biportal endoscopic decompression and flavectomy apply to cervical myelopathy at a single level with an anterior disc and posterior ossified ligamentum flavum complex. Anterior discectomy and fusion were performed in the usual fashion in the supine position, and subsequently, posterior biportal endoscopic decompression was carried out after turning the patient prone. Conclusion: Single-stage anterior discectomy fusion and posterior biportal endoscopic decompression and flavectomy are good alternatives for circumferential decompression with myelopathy [ABSTRACT FROM AUTHOR]

In cervical degenerative myelopathy, spinal canal stenosis causes mechanical compression and thus damage to the spinal cord. Reduced blood flow also plays a role, which can lead to ischemia. In addition, microtraumas are caused by instability. Ultimately, apoptosis and necrosis of the neuronal tissue result. In addition to local pain in the neck, the damage to the spinal cord leads to impaired fine motor skills, unsteady gait, sensory disturbances and paresis. A spastic-atactic gait pattern is typical. Besides, there are often additional radicular complaints. MRI shows spinal stenosis and spinal cord compression. A hyperintense lesion on the T2-weighted image is typical. The severity of myelopathy is determined using the mJOA score. Surgery is recommended for moderate and severe myelopathies, while conservative therapy is also an option for mild myelopathy. Various surgical procedures are available. Ventral decompression with fusion is possible, as is dorsal decompression through laminectomy with screw fixation or laminoplasty. [ABSTRACT FROM AUTHOR]

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Neurologie Pro Praxi is the property of SOLEN sro and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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. [ABSTRACT FROM AUTHOR]

Background Context: Tandem spinal stenosis (TSS) refers to a narrowing of the spinal canal in distinct, noncontiguous regions. TSS most commonly occurs in the cervical and lumbar regions. Decompressive surgery is indicated for those with cervical myelopathy or persistent symptoms from lumbar stenosis despite conservative management. Surgical management typically involves staged procedures, with cervical decompression taking precedence in most cases, followed by lumbar decompression at a later time. However, several studies have shown favorable outcomes in simultaneous decompression.Purpose: The aim of this study is to provide a literature review and compare surgical outcomes in patients undergoing staged vs simultaneous surgery for TSS.Study Design/setting: Systematic literature review.Methods: A systematic review using PRISMA guidelines to identify original research articles for tandem spinal stenosis. PubMed, Cochrane, Ovid, Scopus, and Web of Science were used for electronic literature search. Original articles from 2005 to 2021 with more than eight adult patients treated surgically for cervical and lumbar TSS in staged or simultaneous procedures were included. Articles including pediatric patients, primarily thoracic stenosis, stenosis secondary to neoplasm or infectious disease, minimally invasive surgery, and non-English language were excluded. Demographic, perioperative, complications, functional outcome, and neurologic outcome data including mJOA (modified Japanese Orthopaedic Association), Nurick grade (NG), and ODI (Oswestry disability index), were extracted and summarized.Results: A total of 667 articles were initially identified. After preliminary screening, 21 articles underwent full-text screening. Ten articles met our inclusion criteria. A total of 831 patients were included, 571 (68%) of them underwent staged procedures, and 260 (32%) underwent simultaneous procedures for TSS. Mean follow-ups ranged from 12 to 85 months. There was no difference in estimated blood loss (EBL) between staged and simultaneous groups (p=.639). Simultaneous surgeries had shorter surgical time than staged surgeries (p<.001). Mean changes in mJOA, NG, and ODI was comparable between staged and simultaneous groups. Complications were similar between the groups. There were more major complications reported in simultaneous operations, although this was not statistically significant (p=.301).Conclusion: Staged and simultaneous surgery for TSS have comparable perioperative, functional, and neurologic outcomes, as well as complication rates. Careful selection of candidates for simultaneous surgery may reduce the length of stay and consolidate rehabilitation, thereby reducing hospital-associated costs. [ABSTRACT FROM AUTHOR]

Summary: We present the case of a 74-year-old patient who initially suffered transient tetraplegia after a skiing accident. On presentation to the general practitioner, pyramidal tract signs as well as disturbances of fine motor function in both hands could be observed. MRI examinations of the cervical spine revealed high-grade spinal stenosis at level C5 with myelon compression. Surgical decompression of the spial cord, followed by fusion of the corresponding cervical vertebral bodies, was performed. After surgery and three weeks of neurological rehabilitation, the patient feels well and has recovered except for still existing hypesthesia of the fingertips. [ABSTRACT FROM AUTHOR]

Objective To analyze correlations between the selection of microtitanium plates with different specifications for use in a cervical vertebral dome expansion laminoplasty. Methods Sixteen patients that underwent the cervical vertebral dome expansion laminoplasty with a cervical spinal stenosis angioplasty procedure for treatment of their cervical spinal cords were recruited at our hospital. From February 2017 to September 2018, medical records confirmed that all patients underwent cervical CT and MRI tests pre‐ and postsurgery. The anteroposterior diameter of the spinal canal, changes in the cross‐sectional area of the spinal canal, and the pre‐ and postsurgery distance of the cervical spinal cord after applying microtitanium plates with different lengths were measured by Mimics version 17.0 software (Materialise NV, Leuven, Belgium). A statistical regression and correlation analysis of relevant specification parameters of the microtitanium plate was then studied. Results As the size of the microtitanium plate increased, we found that the cross‐sectional area of cervical spinal canal and distance between the descendants of the lamina and the distance of cervical spinal cord concordantly increased, and these data changes linearly. The regression equation associated with sagittal diameter, cross‐sectional area, and posterior movement distance of the cervical spinal cord was obtained. Conclusion According to the correlation analysis of imaging data changes, the regression equation was obtained to guide the selection of microtitanium plates with appropriate specifications in a cervical vertebral dome expansion laminoplasty.

Objective: To analyze correlations between the selection of microtitanium plates with different specifications for use in a cervical vertebral dome expansion laminoplasty. Methods: Sixteen patients that underwent the cervical vertebral dome expansion laminoplasty with a cervical spinal stenosis angioplasty procedure for treatment of their cervical spinal cords were recruited at our hospital. From February 2017 to September 2018, medical records confirmed that all patients underwent cervical CT and MRI tests pre‐ and postsurgery. The anteroposterior diameter of the spinal canal, changes in the cross‐sectional area of the spinal canal, and the pre‐ and postsurgery distance of the cervical spinal cord after applying microtitanium plates with different lengths were measured by Mimics version 17.0 software (Materialise NV, Leuven, Belgium). A statistical regression and correlation analysis of relevant specification parameters of the microtitanium plate was then studied. Results: As the size of the microtitanium plate increased, we found that the cross‐sectional area of cervical spinal canal and distance between the descendants of the lamina and the distance of cervical spinal cord concordantly increased, and these data changes linearly. The regression equation associated with sagittal diameter, cross‐sectional area, and posterior movement distance of the cervical spinal cord was obtained. Conclusion: According to the correlation analysis of imaging data changes, the regression equation was obtained to guide the selection of microtitanium plates with appropriate specifications in a cervical vertebral dome expansion laminoplasty. [ABSTRACT FROM AUTHOR]

Some studies have suggested that early surgical treatment can effectively improve the prognosis of cervical spinal cord injury without radiological abnormality, but no research has focused on the development of a prognostic model of cervical spinal cord injury without radiological abnormality. This retrospective analysis included 43 patients with cervical spinal cord injury without radiological abnormality. Seven potential factors were assessed: age, sex, external force strength causing damage, duration of disease, degree of cervical spinal stenosis, Japanese Orthopaedic Association score, and physiological cervical curvature. A model was established using multiple binary logistic regression analysis. The model was evaluated by concordant profiling and the area under the receiver operating characteristic curve. Bootstrapping was used for internal validation. The prognostic model was as follows: logit(P) = −25.4545 + 21.2576VALUE + 1.2160SCORE − 3.4224TIME, where VALUE refers to the Pavlov ratio indicating the extent of cervical spinal stenosis, SCORE refers to the Japanese Orthopaedic Association score (0–17) after the operation, and TIME refers to the disease duration (from injury to operation). The area under the receiver operating characteristic curve for all patients was 0.8941 (95% confidence interval, 0.7930–0.9952). Three factors assessed in the predictive model were associated with patient outcomes: a great extent of cervical stenosis, a poor preoperative neurological status, and a long disease duration. These three factors could worsen patient outcomes. Moreover, the disease prognosis was considered good when logit(P) ≥ −2.5105. Overall, the model displayed a certain clinical value. This study was approved by the Biomedical Ethics Committee of the Second Affiliated Hospital of Xi’an Jiaotong University, China (approval number: 2018063) on May 8, 2018.

Study Design: .: Post-hoc analysis of a prospective observational cohort study.Objective: .: To compare clinical outcomes following laminectomy and fusion versus laminectomy alone in an international series of individuals suffering from degenerative cervical myelopathy (DCM).Summary Of Background Data: .: Significant controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for DCM. A previous study comparing laminectomy and fusion with laminoplasty showed no differences in outcomes between groups after adjusting for preoperative characteristics.Methods: .: Based on the operation they received, 208 of the 757 patients prospectively enrolled in the AO Spine North America or International studies at 26 global sites were included in the present study. Twenty-two patients were treated with laminectomy alone and 186 received a laminectomy with fusion. Patients were evaluated using the modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index, and SF36 quality of life measure. Baseline and surgical characteristics were compared using a t test for continuous variables and a chi-square test for categorical variables. A mixed model analytic approach was used to evaluate differences in outcomes at 24 months between patients undergoing laminectomy and fusion versus laminectomy alone.Results: .: Surgical cohorts were comparable in terms of preoperative patient characteristics. Patients undergoing laminectomy with instrumented fusion had a significantly longer operative duration (P < 0.0001, 231.44 vs. 107.10 min) but a comparable length of hospital stay. In terms of outcomes, patients treated with laminectomy with fusion exhibited clinically meaningful improvements (in functional impairmentΔmJOA = 2.48, ΔNurick = 1.19), whereas those who underwent a laminectomy without fusion did not (ΔmJOA = 0.78; ΔNurick = 0.29). There were significant differences between surgical cohorts in the change in mJOA and Nurick scores from preoperative to 24-months postoperative (mJOA: -1.70, P = 0.0266; Nurick: -0.90, P = 0.0241). The rate of perioperative complications was comparable (P = 0.879).Conclusion: .: Our findings suggest that cervical laminectomy with instrumented fusion is more effective than laminectomy alone at improving functional impairment in patients with DCM. These results warrant confirmation in larger prospective comparative studies.Level Of Evidence: 2. [ABSTRACT FROM AUTHOR]

The adult spinal cord is typically resistant to hypoxic-ischemic injury because of collateral blood supply; however, congenital or acquired stenosis may result in baseline maximal vasodilation, such as superimposed hemodynamic stresses, that cannot be accommodated, leaving the spinal cord vulnerable to ischemic injury. We present a rare case of spinal cord hypoxic-ischemic injury in an adult with underlying cervical spinal stenosis. A 37-year-old man with a history of morbid obesity, diabetes mellitus, hypertension, and obstructive sleep apnea presented after developing progressive weakness in the extremities. Preoperative computed tomography myelography demonstrated ossification of the posterior longitudinal ligament and severe spinal canal narrowing. Approximately 1 week after posterior decompression, the patient experienced spinal hypoxic-ischemic injury. Imaging revealed cord expansion and abnormal T2 signal intensity. Axial diffusion tensor images of the brain revealed delayed ischemic leukoencephalopathy with restricted diffusion in the cerebral cortex and deep white matter; this led to the decision to withdraw care, and the patient died. We hypothesize that vascular dysregulation due to cervical stenosis made the cord parenchyma vulnerable to hypoxic and/or hypoperfusion stresses. [ABSTRACT FROM AUTHOR]

Background: Cervical spinal stenosis (CSS) is defined as an abnormal narrowing of the cervical spinal canal. The essential clinical challenges with CSS are altered cervical spinal cord function and cervical radiculopathy. Phrenic nerve palsy leading to hemidiaphragmatic paresis may be a temporary or persistent phenomenon after cervical cord injury and CSS. Objective: The objective of the study is to elucidate the potential effect of CSS on the pulmonary functions. Methods: This is a case–control study which included 40 patients divided into two groups 30 females and 10 males patients with CSS (C5 and above) and 60 healthy volunteers with body mass index (BMI) <30 Kg/m2. Pulmonary function tests have been done for all the patients. Results: The present study showed that VC in expiration (VC EX%), forced expiratory volume (FEV%), forced vital capacity % (FVC%), PEF%, and mean voluntary ventilation % (MVV%), were low in patients CSS compared with the control groups; P < 0.001, P < 0.001, P < 0.001, P = 0.042, and P = 0.037, respectively. As well, VC EX%, FEV1%, and FVC% were low in male patients in comparison to the controls P < 0.05. Besides, there were no significant differences regarding age, BMI, VC in inspiration (VC IN%), PEF%, FEV1/FVC%, and MVV%. Moreover, VC EX%, FEV1%, and FVC% were low in female patients compared to the controls, P < 0.001. Whereas, there were no significant differences that had been identified between female patients and female controls regarding age, BMI, VC IN%, PEF%, FEV1/FVC%, and MVV%. On the other hand, weight, height, and MVV% were low in female patients compared to male patients, P < 0.001. Conclusion: Chronic CSS leads to subclinical pulmonary dysfunction due to the involvement of the phrenic nerve. FEV% is the most sensitive parameter in the detection these disorders. [ABSTRACT FROM AUTHOR]

Background: Cervical spinal stenosis is well-defined as debility in the volume of the spinal canal. Consequently, distracting in the descending neural pathways at any level in the cervical spine lead to impaired smooth and effective breathing under normal conditions . Objective: To assess the effect of cervical spinal stenosis (C5and above) on pulmonary function tests, to assess the sensitivity and specificity of pulmonary function tests in patient with cervical spinal stenosis(C5 and above). Methods: This is a case-control study which included 40 patients divided into two groups 30 females and 10 males patients with cervical spinal stenosis (C5 and above) and 60 healthy volunteers with body mass index < 30 (Kg/m²). Pulmonary function tests has been done for all subjects. Results: The results demonstrate the comparison between all patients and controls show that VC EX%,FEV1%,FVC%,PEF%,MVV%, were significantly lower in patients in comparison to control groups as well as VC EX %,FEV1%,FVC % were significantly lower in male patients in comparison to controls and in female patients as compared to female controls and MVV% were significantly lower in female patients in comparison to male patients,while no significant difference has been identified between patients and controls regarding age,weight, height, BMI,VC IN% and FEV1YFVC %. Sensitivity and specificity and cut off value for pulmonary function tests parameters show FEV1% is the highest specificity and sensitivity. Conclusion: The respiratory dysfunction that is established in patients with cervical spinal stenosis usually subclinical not overt defect that compromised respiration,this pulmonary dysfunction is a type of restrictive lung disease since phrenic nerve is affected. . FEVI% is most essential among other parameters of spirometry in patients with cervical spinal stenosis. [ABSTRACT FROM AUTHOR]

A congenitally narrow cervical spinal canal has been established as an important risk factor for the development of cervical spondylotic myelopathy. However, few reports have described the mechanism underlying this risk. In this study, we investigate the relationship between cervical spinal canal narrowing and pathological changes in the cervical spine using positional magnetic resonance imaging (MRI). Two hundred and ninety-five symptomatic patients underwent cervical MRI in the weight-bearing position with dynamic motion (flexion, neutral, and extension) of the cervical spine. The sagittal cervical spinal canal diameter and cervical segmental angular motion were measured and calculated. Each segment was assessed for the extent of intervertebral disc degeneration and cervical cord compression. Based on the sagittal canal diameter, the subjects were classified into three groups: A, subjects with a congenitally narrow canal, diameter of less than 13 mm; B, subjects with a normal canal, diameter of 13–15 mm; C, subjects with a wide canal, diameter of more than 15 mm. When compared with Groups A and B, the disc degeneration grades at the C3-4, C5-6, and C6-7 segments and the cervical cord compression scores at the C3-4 and C5-6 segments showed significant differences. Additionally, when compare with Groups A and C, the disc degeneration grades at all segments, except C2-3, and the cervical cord compression scores at all segments, except C2-3, showed significant differences. With respect to the cervical kinematics, few differences in the kinematics were observed between Groups B and C, however, the kinematics in Group A was different with other two groups. In Group A, the segmental mobility at the C4-5 and C6-7 segments were significantly higher than those observed in Group B, and the segmental mobility at the C3-4 segment was significantly lower than that observed in Groups B or C. We demonstrated the unique pathological and kinematic traits of cervical spine that exist in a congenitally narrow canal. We hypothesize that kinematic trait associated with a congenitally narrow canal may greatly contribute to pathological changes in the cervical spine. Our results suggest that cervical spinal canal diameter of less than 13 mm may be associated with an increased risk for development of pathological changes in cervical intervertebral discs. Subsequently, the presence of a congenitally narrow canal can expose individuals to a greater risk of developing cervical spinal stenosis.

Background: The authors compared the clinical, MR, and clinical outcomes for patients with multilevel cervical spondylotic myelopathy (MCSM) who underwent laminoplasty (LP) versus laminectomy with fusion (LPSF)., Materials and Methods: The authors evaluated 65 patients with MCSM (2019-2021) with 31 undergoing LP versus 34 having LPSF. Variables studied included JOA scores, T2W MR hyperintense cord signals, preoperative lordosis, number of stenotic levels, and neurological outcomes., Results: Both groups showed similar preoperative JOA scores, number of stenotic levels, T2-weighted MR hyperintense cord signals, and nearly identifcal 12-month postoperative outcomes (good for 83.9 in the LP group vs. 85.3% in the LPSF group). Differences included: higher preoperative visual analog scale in the LPSF versus LP group, plus the LPSF patients significantly less preoperative cervical lordosis versus LP patients., Conclusion: LP and LPSF used to treat MCSM resulted in similar clinical improvement and 1-year postoperative outcomes. However, our recommendation would be for patients with neck pain, instability, and/or cervical kyphosis to undergo LPSF., Competing Interests: All authors declare no conflicts of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Study Design: A retrospective cohort study.Objective: The aim of this study was to compare the feasibility of posterior cervical laminoforaminotomy (PCF) for V- or parallel-shaped foraminal stenosis (FS).Summary Of Background Data: During PCF, the need for extensive facet resection would depend on the extent of any pathology. When resection is extensive, the possibilities of instability and incomplete decompression should be considered.Methods: From March 2004 to March 2015, we enrolled 36 patients following single-level PCF procedures for FS. We classified patients by foraminal shape on preoperative computed tomography (CT) scan into V-shaped and parallel-shaped groups. We then compared arm and neck pain using a numeric rating scale (NRS) and clinical outcomes using Odom criteria. Radiological evaluation included dynamic X-rays for instability and CT scans for facet resection.Result: We enrolled 16 and 20 patients in the V-shape and parallel-shape groups, respectively. By Odom criteria, no patient was graded fair or poor in the V group, but five patients were graded as fair and one patient as poor in the parallel group. Continued postoperative arm pain at 1 year, which was related to incomplete decompression, was significantly higher in parallel group. Only one patient complained of postoperative neck pain with an NRS >5, and another five patients sustained radiculopathy with an NRS >5. Among five patients who complained sustained radiculopathy, one patient required revision surgery for incomplete decompression. The amount of facet removal was not different significantly between groups, and no patient had postoperative instability.Conclusion: Although PCF seems to be a good surgical option for V-shaped FS, we experienced worse outcomes for patients with parallel-shaped FS. We recommend that ACDF or more aggressive posterior foraminotomy be performed with fusion when presented with parallel neuroforaminal compression.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to develop a simple and clinically useful morphological classification system for congenital lumbar spinal stenosis using sagittal MRI, allowing clinicians to recognize patterns of lumbar congenital stenosis quickly and be able to screen these patients for tandem cervical stenosis.Methods: Forty-four subjects with an MRI of both the cervical and lumbar spine were included. On the lumbar spine MRI, the sagittal canal morphology was classified as one of three types: Type I normal, Type II partially narrow, Type III globally narrow. For the cervical spine, the Torg-Pavlov ratio on X-ray and the cervical spinal canal width on MRI were measured. Kruskal-Wallis analysis was done to determine if there was a relationship between the sagittal morphology of the lumbar spinal canal and the presence of cervical spinal stenosis.Results: Subjects with a type III globally narrow lumbar spinal canal had a significantly lower cervical Torg-Pavlov ratio and smaller cervical spinal canal width than those with a type I normal lumbar spinal canal.Conclusion: A type III lumbar spinal canal is a globally narrow canal characterized by a lack of spinal fluid around the conus. This was defined as "functional lumbar spinal stenosis" and is associated with an increased incidence of tandem cervical spinal stenosis. [ABSTRACT FROM AUTHOR]