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Michael G Fehlings - One of the best experts on this subject based on the ideXlab platform.

  • Multidisciplinary approach to degenerative Cervical Myelopathy.
    Expert review of neurotherapeutics, 2020
    Co-Authors: Ali Moghaddamjou, Jamie R F Wilson, Allan R. Martin, Harry Gebhard, Michael G Fehlings
    Abstract:

    Degenerative Cervical Myelopathy (DCM) is a prevalent condition causing significant impairment spanning several domains of health. A multidisciplinary approach to the care of DCM would be ideal in ...

  • Degenerative Cervical Myelopathy: Diagnosis and management in primary care.
    Canadian family physician Medecin de famille canadien, 2019
    Co-Authors: James Milligan, Michael G Fehlings, Kayla Ryan, Craig Bauman
    Abstract:

    Abstract Objective To raise awareness about degenerative Cervical Myelopathy (DCM) and to help family physicians identify, diagnose, and manage DCM more effectively. Sources of information A PubMed search was conducted for articles published between 1970 and October 2017, using the terms Cervical Myelopathy and degenerative spinal cord injury with family medicine or primary care. Main message Owing to limited knowledge of DCM in primary care, along with the large variability of the disease, the diagnosis of DCM is often missed or delayed. The natural course of DCM presents as a stepwise decline, with symptoms ranging from muscle weakness to complete paralysis. All individuals with signs and symptoms should be referred to a spine surgeon for consideration of surgery; those with mild DCM might be offered conservative treatment but should receive a surgical evaluation and opinion nonetheless. Asymptomatic patients with evidence of cord compression on magnetic resonance imaging might need to be referred for assessment; however, surgery is not advised. It is critical to closely monitor asymptomatic individuals or those with mild DCM for neurologic deterioration. Conclusion Degenerative Cervical Myelopathy is the most common cause of spinal cord dysfunction in adults. This review helps streamline its diagnosis in primary care, allowing for improved chances of early diagnosis and prevention of further neurologic decline among patients.

  • Degenerative Cervical Myelopathy
    CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2016
    Co-Authors: Christopher D. Witiw, Michael G Fehlings
    Abstract:

    Degenerative Cervical Myelopathy comprises age-related degenerative pathologies of the Cervical spinal column that lead to Myelopathy from compression of the spinal cord. These include osteoarthritic degeneration (Cervical spondylosis) and ligamentous aberrations (ossification of the posterior

  • degenerative Cervical Myelopathy epidemiology genetics and pathogenesis
    Spine, 2015
    Co-Authors: Aria Nouri, Lindsay Tetreault, Anoushka Singh, Spyridon K Karadimas, Michael G Fehlings
    Abstract:

    Study design Review. Objective To formally introduce "degenerative Cervical Myelopathy" (DCM) as the overarching term to describe the various degenerative conditions of the Cervical spine that cause Myelopathy. Herein, the epidemiology, pathogenesis, and genetics of conditions falling under this hypernym are carefully described. Summary of background data Nontraumatic, degenerative forms of Cervical Myelopathy represent the commonest cause of spinal cord impairment in adults and include Cervical spondylotic Myelopathy, ossification of the posterior longitudinal ligament, ossification of the ligamentum flavum, and degenerative disc disease. Unfortunately, there is neither a specific term nor a specific diagnostic International Classification of Diseases, Tenth Revision code to describe this collection of clinical entities. This has resulted in the inconsistent use of diagnostic terms when referring to patients with Myelopathy due to degenerative disease of the Cervical spine. Methods Narrative review. Results The incidence and prevalence of Myelopathy due to degeneration of the spine are estimated at a minimum of 41 and 605 per million in North America, respectively. Incidence of Cervical spondylotic Myelopathy-related hospitalizations has been estimated at 4.04/100,000 person-years, and surgical rates seem to be rising. Pathophysiologically, Myelopathy results from static compression, spinal malalignment leading to altered cord tension and vascular supply, and dynamic injury mechanisms. Occupational hazards, including transportation of goods by weight bearing on top of the head, and other risk factors may accelerate DCM development. Potential genetic factors include those related to MMP-2 and collagen IX for degenerative disc disease, and collagen VI and XI for ossification of the posterior longitudinal ligament. In addition, congenital anomalies including spinal stenosis, Down syndrome, and Klippel-Feil syndrome may predispose to the development of DCM. Conclusion Although DCMs can present as separate diagnostic entities, they are highly interrelated, frequently manifest concomitantly, present similarly from a clinical standpoint, and seem to be in part a response to compensate and improve stability due to progressive age and wear of the Cervical spine. The use of the term "degenerative Cervical Myelopathy" is advocated. Level of evidence 5.

  • Pathophysiology of Cervical Myelopathy.
    The spine journal : official journal of the North American Spine Society, 2006
    Co-Authors: Darryl C Baptiste, Michael G Fehlings
    Abstract:

    Cervical Myelopathy is a group of closely related disorders usually caused by spondylosis or by ossification of the posterior longitudinal ligament and is characterized by compression of the Cervical spinal cord or nerve roots by varying degrees and number of levels. The decrease in diameter of the vertebral canal secondary to disc degeneration and osteophytic spurs compresses the spinal cord and nerve roots at one or several levels, producing direct damage and often secondary ischemic changes. Clinicians who treat Cervical Myelopathy cord injuries should have a basic understanding of the pathophysiology and the processes that are initiated after the spinal cord has been injured. Literature review. Literature review of human Cervical Myelopathy and clinically relevant animal models to further our understanding of the pathological mechanisms involved. The pathophysiology of Cervical Myelopathy involves static factors, which result in acquired or developmental stenosis of the Cervical canal and dynamic factors, which involve repetitive injury to the Cervical cord. These mechanical factors in turn result in direct injury to neurons and glia as well as a secondary cascade of events including ischemia, excitotoxicity, and apoptosis; a pathobiology similar to that occurring in traumatic spinal cord injury. This review summarizes some of the significant pathophysiological processes involved in Cervical Myelopathy.

N. V. Todd - One of the best experts on this subject based on the ideXlab platform.

  • Cervical Myelopathy in Rheumatoid Arthritis
    Neurology research international, 2011
    Co-Authors: N. Mukerji, N. V. Todd
    Abstract:

    Involvement of the Cervical spine is common in rheumatoid arthritis. Clinical presentation can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We discuss the pathology, grading systems, clinical presentation, indications for surgery and surgical management of Cervical Myelopathy related to rheumatoid arthritis in this paper. We describe our surgical technique and results. We recommend early consultation for surgical management when involvement of the Cervical spine is suspected in rheumatoid arthritis. Even patients with advanced Cervical Myelopathy should be discussed for surgical treatment, since in our experience improvement in function after surgery is common.

  • SURGICAL MANAGEMENT OF RANAWAT IIIB RHEUMATOID Cervical Myelopathy
    2002
    Co-Authors: R. Nannapaneni, N. V. Todd
    Abstract:

    Objective : To reassess whether the Ranawat IIIB (quadriparetic, non-ambulant) rheumatoid arthritis (RA) with Cervical Myelopathy patients should be surgically treated. Study Design: Retrospective study Subjects: Over a 12-year period (1988–1999), 51 patients [15 M: 36F; mean age 64 years] in Ranawat IIIB with RA were diagnosed to have Cervical Myelopathy. These included 47 patients with atlantoaxial subluxation (AAS) [15 with AAS alone, 10 with basilar invagination (BI), 18 with associated subaxial subluxation (SAS) and four patients with BI and SAS] and four patients with SAS alone. Results: Thirty-two patients considered fit for surgery successfully underwent operative treatment (Group 1). All underwent posterior instrumented fixation with or without transoral odontoid peg excision. Postoperatively 22/27 patients were pain free and 21/32 patients initially non-ambulant were able to walk. 3/26 patients died within six months of surgery. 13/19 patients managed conservatively (Group 2) because of medical complications died within six months of presentation. Conclusions: Even in advanced stages of Cervical Myelopathy in RA, surgical intervention is beneficial with significantly higher morbidity/mortality in conservatively managed patients.

Masahiro Kurosaka - One of the best experts on this subject based on the ideXlab platform.

  • The influence of proprioceptive impairment on hand function in patients with Cervical Myelopathy.
    Spine, 2006
    Co-Authors: Minoru Doita, Toshihiko Harada, Hiroshi Sakai, Kotaro Nishida, Hiroshi Miyamoto, Tasuku Kaneko, Masahiro Kurosaka
    Abstract:

    STUDY DESIGN A prospective clinical study. OBJECTIVES To quantitatively evaluate hand function in patients with Cervical Myelopathy and to assess the influence of proprioceptive impairment on hand function in patients with Cervical Myelopathy. SUMMARY OF BACKGROUND DATA Clumsiness of the hands is one of the most common complaints in patients with Cervical Myelopathy. However, few reports have been published that evaluate hand dysfunction, and no reports have assessed the association between hand function and proprioceptive impairment. PATIENTS AND METHODS A total of 129 patients (36 women and 93 men) with Cervical Myelopathy were examined. Hand function was evaluated as scores of ten subtests designed on the basis of various hand activities. The degree of proprioceptive impairment of the hand as well as that of light touch sensation loss is classified into four grades. Scores of the hand function test are compared according to the grade of proprioceptive impairment of the hands. RESULTS Significant relation between the impairment of hand function and the extent of Cervical Myelopathy was observed. There was good correlation between the hand function scores and the grade of impairment of proprioception and light touch sensation. Furthermore, patients with impairment of proprioception obtained significantly lower scores in the hand function test than those with loss of light touch sensation. CONCLUSIONS The hand function test is a useful battery to objectively and quantitatively evaluate impairment of Cervical Myelopathy, although longitudinal studies are needed to determine its practical usability. There was some relation between scores of hand function test and the extent of proprioceptive impairment. Thus, hand function test may be partly influenced by proprioceptive loss.

  • Evaluation of impairment of hand function in patients with Cervical Myelopathy.
    Journal of spinal disorders & techniques, 2006
    Co-Authors: Minoru Doita, Toshihiko Harada, Hiroshi Sakai, Kotaro Nishida, Hiroshi Miyamoto, Tasuku Kaneko, Masahiro Kurosaka
    Abstract:

    Clumsiness of the hands is one of the most common complaints in patients with Cervical Myelopathy. However, few reports have been published that evaluate hand dysfunction. One hundred and twenty-nine patients (36 women and 93 men) with Cervical Myelopathy were examined and results compared with those of age- and sex-matched controls. Hand function was evaluated as scores of 10 subtests designed on the basis of various hand activities. Patients with Cervical Myelopathy obtained significantly lower scores on the hand function test in each age-group than controls. There was good correlation between hand function scores and the extent of Cervical Myelopathy. Therefore, the hand function test is a useful battery to objectively and quantitatively evaluate impairment of Cervical Myelopathy, although longitudinal studies are needed to determine its practical usability.

  • Impaired joint proprioception in patients with Cervical Myelopathy.
    Spine, 2005
    Co-Authors: Hiroyuki Takayama, Hirotsugu Muratsu, Minoru Doita, Toshihiko Harada, Shinichi Yoshiya, Masahiro Kurosaka
    Abstract:

    STUDY DESIGN Prospective clinical study. OBJECTIVES To evaluate impairment of proprioception quantitatively in patients with Cervical Myelopathy. SUMMARY OF BACKGROUND DATA Sensory information regarding proprioception ascends through the posterior columns in the spinal cord. Damage to these columns causes proprioceptive loss in patients with spondylotic Myelopathy. Nevertheless, there have been few studies regarding proprioception in patients with Myelopathy. METHODS The authors evaluated knee proprioception in 54 Cervical Myelopathy patients and compared results with those of 54 age-matched healthy volunteers. Knee proprioception was assessed by joint position sense, represented by the error angles when patients reproduced predetermined angles of knee flexion. RESULTS The average absolute angle error of right and left knee with the predetermined position of 30 degrees of knee flexion was 2.5 +/- 1.8 (mean +/- standard deviation) and 1.8 +/- 1.2 degrees and with the predetermined 60 degrees of flexion, 4.7 +/- 2.8 and 2.8 +/- 1.4 degrees in the Myelopathy and control groups, respectively. The average absolute angular errors in the Myelopathy group were significantly higher than those in the control group for each predetermined knee position (P < 0.01). CONCLUSIONS Proprioceptive ability is impaired in patients with Cervical Myelopathy. Position sense can be assessed by measuring the angular error when reproducing criterion positions, and the results may reflect the severity of Cervical Myelopathy. Thus, the present method of measuring proprioception is easy to perform and useful for quantitative assessment of the severity of Cervical Myelopathy.

Kozo Nakamura - One of the best experts on this subject based on the ideXlab platform.

  • Correlation between pyramidal signs and the severity of Cervical Myelopathy
    European spine journal : official publication of the European Spine Society the European Spinal Deformity Society and the European Section of the Cerv, 2010
    Co-Authors: Hirotaka Chikuda, Atsushi Seichi, Hiroshi Kawaguchi, Katsushi Takeshita, Naoki Shoda, Takashi Ono, Ko Matsudaira, Kozo Nakamura
    Abstract:

    A retrospective study was performed to determine the sensitivities of the pyramidal signs in patients with Cervical Myelopathy, focusing on those with increased signal intensity (ISI) in T2-weighted magnetic resonance imaging (MRI). The relationship between prevalence of the pyramidal signs and the severity of Myelopathy was investigated. We reviewed the records of 275 patients with Cervical Myelopathy who underwent surgery. Of these, 143 patients were excluded from this study due to comorbidities that might complicate neurological findings. The MR images of the remaining 132 patients were evaluated in a blinded fashion. The neurological findings of 120 patients with ISI (90 men and 30 women; mean age 61 years) were reviewed for hyperreflexia (patellar tendon reflex), ankle clonus, Hoffmann reflex, and Babinski sign. To assess the severity of Myelopathy, the motor function scores of the upper and lower extremities for Cervical Myelopathy set by the Japanese Orthopaedic Association (m-JOA score) were used. The most prevalent signs were hyperreflexia (94%), Hoffmann reflex (81%), Babinski sign (53%), and ankle clonus (35%). Babinski sign (P < 0.001), ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. Conversely, no association was found with the upper m-JOA score. In patients with Cervical Myelopathy, hyperreflexia showed the highest sensitivity followed by Hoffmann reflex, Babinski sign, and ankle clonus. The prevalence of the pyramidal signs correlated with increasing severity of Myelopathy. Considering their low sensitivity in patients with mild disability, the pyramidal signs may have limited utility in early diagnosis of Cervical Myelopathy.

  • Bone resorption of the facet joint in rheumatoid arthritis as a predictor of lower Cervical Myelopathy.
    Modern rheumatology, 2005
    Co-Authors: Takeshi Matsumoto, Atsushi Seichi, Yoshiaki Kuga, Hiromi Oda, Kozo Nakamura
    Abstract:

    The purpose of the present study was to identify the risk factors to predict instability of the subaxial Cervical spine and Cervical Myelopathy based on plain radiographs. The study was performed on 99 patients with mutilating rheumatoid arthritis (RA). From plain lateral radiographs of the Cervical spine over time, rheumatoid Cervical spine lesions were investigated and evaluation was made on the possibility to develop Cervical Myelopathy. The incidence of subaxial Cervical spine lesions in the patients with mutilating RA was as high as 98%. In particular, resorption of the superior facet suggests high risk to develop Cervical Myelopathy. The presence of spinous process erosion is also likely to reveal such a possibility. There was no statistically significant difference in the anteroposterior diameter of Cervical spinal canal between the cases with Cervical Myelopathy and those without it. Resorption of the superior facet is the most important factor for the development of Cervical Myelopathy. In the cases with rheumatoid Cervical spine lesions, it is necessary to take special notice of the superior facet.

  • Cervical Myelopathy in an adult due to atlantoaxial subluxation associated with Down syndrome: a case study
    Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2003
    Co-Authors: Kazuhiro Masuda, Motoshige Iwasaki, Atsushi Seichi, Tomoaki Kitagawa, Susumu Nakajima, Hiroshi Kawaguchi, Isao Ohnishi, Kozo Nakamura
    Abstract:

    Atlantoaxial subluxation resulting in Cervical Myelopathy in patients with Down syndrome has been well documented. The risk of Cervical Myelopathy is reported to decrease with age, and reports of adult-onset cases are limited. We report an adult patient with Down syndrome who developed Cervical Myelopathy and was successfully treated by surgery. Because there is little information on this condition with adult onset, we report the features of the radiographic findings. Particular care over the long term should be taken in those who have atlantoaxial subluxation combined with odontoid hypoplasia or accessory ossicles, as they are at particular risk of Cervical Myelopathy even during adulthood.

N. Mukerji - One of the best experts on this subject based on the ideXlab platform.

  • Cervical Myelopathy in Rheumatoid Arthritis
    Neurology research international, 2011
    Co-Authors: N. Mukerji, N. V. Todd
    Abstract:

    Involvement of the Cervical spine is common in rheumatoid arthritis. Clinical presentation can be variable, and symptoms may be due to neck pain or compressive myeloradiculopathy. We discuss the pathology, grading systems, clinical presentation, indications for surgery and surgical management of Cervical Myelopathy related to rheumatoid arthritis in this paper. We describe our surgical technique and results. We recommend early consultation for surgical management when involvement of the Cervical spine is suspected in rheumatoid arthritis. Even patients with advanced Cervical Myelopathy should be discussed for surgical treatment, since in our experience improvement in function after surgery is common.