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Michael G Fehlings - One of the best experts on this subject based on the ideXlab platform.
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degenerative cervical Myelopathy epidemiology genetics and pathogenesis
Spine, 2015Co-Authors: Aria Nouri, Lindsay Tetreault, Anoushka Singh, Spyridon K Karadimas, Michael G FehlingsAbstract: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.
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frequency timing and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression canal stenosis and or ossification of the posterior longitudinal ligament
Spine, 2013Co-Authors: Jefferson R Wilson, Sean Barry, Dena J Fischer, Andrea C Skelly, Paul M Arnold, Daniel K Riew, Christopher I Shaffrey, Vincent C Traynelis, Michael G FehlingsAbstract:STUDY DESIGN Systematic review and survey. OBJECTIVE To perform an evidence synthesis of the literature and obtain information from the global spine care community assessing the frequency, timing, and predictors of symptom development in patients with radiographical evidence of cervical spinal cord compression, spinal canal narrowing, and/or ossification of posterior longitudinal ligament (OPLL) but no symptoms of Myelopathy. SUMMARY OF BACKGROUND DATA Evidence for a marker to predict symptom development remains sparse, and there is controversy surrounding the management of asymptomatic patients. METHODS We conducted a systematic review of the English language literature and an international survey of spine surgeons to answer the following key questions in patients with radiographical evidence of cervical spinal cord compression, spinal canal narrowing, and/or OPLL but no symptoms of Myelopathy: (1) What are the frequency and timing of symptom development? (2) What are the clinical, radiographical, and electrophysiological predictors of symptom development? (3) What clinical and/or radiographical features influence treatment decisions based on an international survey of spine care professionals? RESULTS The initial literature search yielded 388 citations. Applying the inclusion/exclusion criteria narrowed this to 5 articles. Two of these dealt with the same population. For patients with spinal cord compression secondary to spondylosis, one study reported the frequency of Myelopathy development to be 22.6%. The presence of symptomatic radiculopathy, cervical cord hyperintensity on magnetic resonance imaging, and prolonged somatosensory- and motor-evoked potentials were reported in one study as significant independent predictors of Myelopathy development. In contrast, the lack of magnetic resonance imaging hyperintensity was found to be a positive predictor of early Myelopathy development (≤ 12-mo follow-up). For subjects with OPLL, frequency of Myelopathy development was reported in 3 articles and ranged from 0.0% to 61.5% of subjects. One of these studies reported canal stenosis of 60% or more, lateral deviated OPLL, and increased cervical range of motion as significant predictors of Myelopathy development. In a survey of 774 spine surgeons, the majority deemed the presence of clinically symptomatic radiculopathy to predict progression to Myelopathy in nonmyelopathic patients with cervical stenosis. Survey responses pertaining to 3 patient case vignettes are also presented and discussed in the context of the current literature. CONCLUSION On the basis of these results, we provide a series of evidence-based recommendations related to the frequency, timing, and predictors of Myelopathy development in asymptomatic patients with cervical stenosis secondary to spondylosis or OPLL. Future prospective studies are required to refine our understanding of this topic. EVIDENCE-BASED CLINICAL RECOMMENDATIONS: RECOMMENDATION Patients with cervical canal stenosis and cord compression secondary to spondylosis, without clinical evidence of Myelopathy, and who present with clinical or electrophysiological evidence of cervical radicular dysfunction or central conduction deficits seem to be at higher risk for developing Myelopathy and should be counseled to consider surgical treatment. OVERALL STRENGTH OF EVIDENCE Moderate. STRENGTH OF RECOMMENDATION Strong. SUMMARY STATEMENTS: STATEMENT 1: On the basis of the current literature, for patients with cervical canal stenosis and cord compression secondary to spondylosis, without clinical evidence of Myelopathy, approximately 8% at 1-year follow-up and 23% at a median of 44-months follow-up develop clinical evidence of Myelopathy. STATEMENT 2: For patients with cervical canal stenosis and cord compression secondary to spondylosis, without clinical evidence of Myelopathy, the absence of magnetic resonance imaging intramedullary T2 hyperintensity has been shown to predict early Myelopathy development (<12-mo follow-up) and the presence of such signal has been shown to predict late Myelopathy development (mean 44-mo follow-up). In light of this discrepancy, no definite recommendation can be made surrounding the utility of this finding in predicting Myelopathy development. STATEMENT 3: For patients with OPLL but without Myelopathy, no recommendation can be made regarding the incidence or predictors of progression to Myelopathy.
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human neuropathological and animal model evidence supporting a role for fas mediated apoptosis and inflammation in cervical spondylotic Myelopathy
Brain, 2011Co-Authors: Tianyi Liu, Timrasmus Kiehl, Michael G FehlingsAbstract:Although cervical spondylotic Myelopathy is a common cause of chronic spinal cord dysfunction in humans, little is known about the molecular mechanisms underlying the progressive neural degeneration characterized by this condition. Based on animal models of cervical spondylotic Myelopathy and traumatic spinal cord injury, we hypothesized that Fas-mediated apoptosis and inflammation may play an important role in the pathobiology of human cervical spondylotic Myelopathy. We further hypothesized that neutralization of the Fas ligand using a function-blocking antibody would reduce cell death, attenuate inflammation, promote axonal repair and enhance functional neurological outcomes in animal models of cervical spondylotic Myelopathy. We examined molecular changes in post-mortem human spinal cord tissue from eight patients with cervical spondylotic Myelopathy and four control cases. Complementary studies were conducted using a mouse model of cervical spondylotic Myelopathy (twy/twy mice that develop spontaneous cord compression at C2-C3). We observed Fas-mediated apoptosis of neurons and oligodendrocytes and an increase in inflammatory cells in the compressed spinal cords of patients with cervical spondylotic Myelopathy. Furthermore, neutralization of Fas ligand with a function-blocking antibody in twy/twy mice reduced neural inflammation at the lesion mediated by macrophages and activated microglia, glial scar formation and caspase-9 activation. It was also associated with increased expression of Bcl-2 and promoted dramatic functional neurological recovery. Our data demonstrate, for the first time in humans, the potential contribution of Fas-mediated cell death and inflammation to the pathobiology of cervical spondylotic Myelopathy. Complementary data in a murine model of cervical spondylotic Myelopathy further suggest that targeting the Fas death receptor pathway is a viable neuroprotective strategy to attenuate neural degeneration and optimize neurological recovery in cervical spondylotic Myelopathy. Our findings highlight the possibility of medical treatments for cervical spondylotic Myelopathy that are complementary to surgical decompression.
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A review of the pathophysiology of cervical spondylotic Myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury
Spine, 1998Co-Authors: Michael G Fehlings, Ghassan SkafAbstract:Cervical spondylotic Myelopathy (CSM) is the most common cause of spinal cord dysfunction. Despite advances in diagnosis and surgical treatment, many patients still have severe permanent neurologic deficits caused by this condition. An improved understanding of the pathophysiology of cervical spondylotic Myelopathy, particularly at a cellular and molecular level, may allow improved treatments in the future. A detailed review of articles in the literature pertaining to cervical spondylotic Myelopathy was supplemented by an analysis of relevant mechanisms of spinal cord injury. The pathologic course of cervical spondylotic Myelopathy is characterized by early involvement of the corticospinal tracts and later destruction of anterior horn cells, demyelination of lateral and dorsolateral tracts, and relative preservation of anterior columns. Static and mechanical factors and ischemia are critical to the development of cervical spondylotic Myelopathy. Free radical-and cation-mediated cell injury, glutamatergic toxicity, and apoptosis may be of relevance to the pathophysiology of cervical spondylotic Myelopathy. To date, research in cervical spondylotic Myelopathy has focused exclusively on the role of mechanical factors and ischemia. Fundamental research at a cellular and molecular level, particularly in the areas of glutamatergic toxicity and apoptosis may result in clinically relevant treatments for this condition.
Atsushi Seichi - One of the best experts on this subject based on the ideXlab platform.
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Correlation between pyramidal signs and the severity of cervical Myelopathy
European Spine Journal, 2010Co-Authors: Hirotaka Chikuda, Atsushi Seichi, Hiroshi Kawaguchi, Katsushi Takeshita, Naoki Shoda, Takashi Ono, Ko Matsudaira, Kozo NakamuraAbstract: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
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radiographic predictors for the development of Myelopathy in patients with ossification of the posterior longitudinal ligament a multicenter cohort study
Spine, 2008Co-Authors: Shunji Matsunaga, Kozo Nakamura, Atsushi Seichi, Toru Yokoyama, Satoshi Toh, Shoichi Ichimura, Kazuhiko Satomi, Kenji Endo, Kengo Yamamoto, Yoshiharu KatoAbstract:STUDY DESIGN: A multicenter cohort study was performed retrospectively. OBJECTIVE: To identify radiographic predictors for the development of Myelopathy in patients with ossification of the posterior longitudinal ligaments (OPLL). SUMMARY OF BACKGROUND DATA: The pathomechanism of Myelopathy in the OPLL remains unknown. Some patients with large OPLL have not exhibited Myelopathy for a long periods of time. Predicting the course of future neurologic deterioration in asyptomatic patients with OPLL is difficult at their initial visit. METHODS: A total of 156 OPLL patients from 16 spine institutes with an average of 10.3 years of follow-up were reviewed. Subjects underwent a plain roentgenogram, computed tomography (CT), and magnetic resonance imaging of the cervical spine during the follow-up. The trauma history of the cervical spine, maximum percentage of spinal canal stenosis in a plain roentgenogram and CT, range of motion of the cervical spine, and axial ossified pattern in magnetic resonance imaging or CT were reviewed in relation to the existence of Myelopathy. RESULTS: All 39 patients with greater than 60% spinal canal stenosis on the plain roentgenogram exhibited Myelopathy. Of 117 patients with less than 60% spinal canal stenosis, 57 (49%) patients exhibited Myelopathy. The range of motion of the cervical spine was significantly larger in patients with Myelopathy than in those of without it. The axial ossified pattern could be classified into 2 types: a central type and a lateral deviated type. The incidence of Myelopathy in patients with less than 60% spinal canal stenosis was significantly higher in the lateral deviated-type group than in the central-type group. Fifteen patients of 156 subjects developed trauma-induced Myelopathy. Of the 15 patients, 13 had mixed-type OPLL and 2 had segmental-type OPLL. CONCLUSION: Static and dynamic factors were related to the development of Myelopathy in OPLL.
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An outcome measure for patients with cervical Myelopathy : Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) : Part 1
Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2007Co-Authors: Mitsuru Fukui, Atsushi Seichi, Shinichi Kikuchi, Shinichi Konno, Kazuhiro Chiba, Mamoru Kawakami, Masabumi Miyamoto, Tadashi Shimamura, Osamu Shirado, Toshihiko TaguchiAbstract:Background An outcome measure to evaluate the neurological function of cervical Myelopathy was proposed by the Japanese Orthopaedic Association in 1975 (JOA score), and has been widely used in Japan. However, the JOA score does not include patients’ satisfaction, disability, handicaps, or general health, which can be affected by cervical Myelopathy. The purpose of this study was to develop a new outcome measure for patients with cervical Myelopathy.
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long term results of double door laminoplasty for cervical stenotic Myelopathy
Spine, 2001Co-Authors: Atsushi Seichi, Hiroshi Kawaguchi, Katsushi Takeshita, Isao Ohishi, Toru Akune, Yorito Anamizu, Tomoaki Kitagawa, K NakamuraAbstract:Study Design. A retrospective study of the long-term results from double-door laminoplasty (Kurokawa’s method) for patients with Myelopathy caused by ossification of the posterior longitudinal ligament and cervical spondylosis was performed. Objective. To know whether the short-term results from double-door laminoplasty were maintained over a 10-year period and, if not, the cause of late deterioration. Summary of Background Data. There are few long-term follow-up studies on the outcome of laminoplasty for cervical stenotic Myelopathy. Methods. In this study, 35 patients with cervical Myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine and 25 patients with cervical spondylotic Myelopathy, including 5 patients with athetoid cerebral palsy, underwent double-door laminoplasty from 1980 through 1988 and were followed over the next 10 years. The average follow-up period was 153 months (range, 120–200 months) in patients with ossification of the posterior longitudinal ligament and 156 months (range, 121–218 months) in patients with cervical spondylotic Myelopathy. Neurologic deficits before and after surgery were assessed using a scoring system proposed by the Japanese Orthopedic Association (JOA score). Patients who showed late deterioration received further examination including computed tomography scan and magnetic resonance imaging of the cervical spine. Results. In 32 of the patients with ossification of the posterior longitudinal ligament and 23 of the patients with cervical spondylotic Myelopathy, Myelopathy improved after surgery. The improvement of Japanese Orthopedic Association scores was maintained up to the final follow-up assessment in 26 of the patients with ossification of the posterior longitudinal ligament and 21 of the patients with cervical spondylotic Myelopathy. Late neurologic deterioration occurred in 10 of the patients with ossification of the posterior longitudinal ligament an average of 8 years after surgery, and in 4 of the patients with cervical spondylotic Myelopathy, including the 3 patients with athetoid cerebral palsy, an average of 11 years after surgery. The main causes of deterioration in patients with ossification of the posterior longitudinal ligament were a minor trauma in patients with residual cervical cord compression caused by ossification of the posterior longitudinal ligament and thoracic Myelopathy resulting from ossification of the yellow ligament in the thoracic spine. Conclusions. The short-term results of laminoplasty for cervical stenotic Myelopathy were maintained over 10years in 78% of the patients with ossification of the posterior longitudinal ligament, and in most of the patients with cervical spondylotic Myelopathy, except those with athetoid cerebral palsy. Double-door laminoplasty is a reliable procedure for individuals with cervical stenotic Myelopathy.
Shunji Matsunaga - One of the best experts on this subject based on the ideXlab platform.
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radiographic predictors for the development of Myelopathy in patients with ossification of the posterior longitudinal ligament a multicenter cohort study
Spine, 2008Co-Authors: Shunji Matsunaga, Kozo Nakamura, Atsushi Seichi, Toru Yokoyama, Satoshi Toh, Shoichi Ichimura, Kazuhiko Satomi, Kenji Endo, Kengo Yamamoto, Yoshiharu KatoAbstract:STUDY DESIGN: A multicenter cohort study was performed retrospectively. OBJECTIVE: To identify radiographic predictors for the development of Myelopathy in patients with ossification of the posterior longitudinal ligaments (OPLL). SUMMARY OF BACKGROUND DATA: The pathomechanism of Myelopathy in the OPLL remains unknown. Some patients with large OPLL have not exhibited Myelopathy for a long periods of time. Predicting the course of future neurologic deterioration in asyptomatic patients with OPLL is difficult at their initial visit. METHODS: A total of 156 OPLL patients from 16 spine institutes with an average of 10.3 years of follow-up were reviewed. Subjects underwent a plain roentgenogram, computed tomography (CT), and magnetic resonance imaging of the cervical spine during the follow-up. The trauma history of the cervical spine, maximum percentage of spinal canal stenosis in a plain roentgenogram and CT, range of motion of the cervical spine, and axial ossified pattern in magnetic resonance imaging or CT were reviewed in relation to the existence of Myelopathy. RESULTS: All 39 patients with greater than 60% spinal canal stenosis on the plain roentgenogram exhibited Myelopathy. Of 117 patients with less than 60% spinal canal stenosis, 57 (49%) patients exhibited Myelopathy. The range of motion of the cervical spine was significantly larger in patients with Myelopathy than in those of without it. The axial ossified pattern could be classified into 2 types: a central type and a lateral deviated type. The incidence of Myelopathy in patients with less than 60% spinal canal stenosis was significantly higher in the lateral deviated-type group than in the central-type group. Fifteen patients of 156 subjects developed trauma-induced Myelopathy. Of the 15 patients, 13 had mixed-type OPLL and 2 had segmental-type OPLL. CONCLUSION: Static and dynamic factors were related to the development of Myelopathy in OPLL.
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clinical course of patients with ossification of the posterior longitudinal ligament a minimum 10 year cohort study
Journal of Neurosurgery, 2004Co-Authors: Shunji Matsunaga, Takashi Sakou, Eiji Taketomi, Setsuro KomiyaAbstract:Object. Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression. Methods. A total of 450 patients, including 304 managed conservatively and 146 treated by surgery, were enrolled in the study. All patients underwent neurological and radiographical follow-up examinations for a mean of 17.6 years. Myelopathy was graded using Nurick classification and the Japanese Orthopaedic Association scale. Fifty-five (17%) of 323 patients without Myelopathy evident at the first examination developed Myelopathy during the follow-up period. Risk factors associated with the evolution of Myelopathy included greater than 60% OPLL-induced stenotic compromise of the cervical canal, and increased range of motion of the cervical spine. Using Kaplan—...
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pathogenesis of Myelopathy in patients with ossification of the posterior longitudinal ligament
Journal of Neurosurgery, 2002Co-Authors: Shunji Matsunaga, Takashi Sakou, Makoto Kukita, Kyoji Hayashi, Reiko Shinkura, Chihaya Koriyama, Setsuro KomiyaAbstract:Object. The goal of this study was to clarify the pathogenesis of Myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) based on the relationship between static compression factors and dynamic factors. Methods. There was a total of 247 patients, including 167 patients who were conservatively followed for a mean of 11 years and 2 months and 80 patients who had Myelopathy at initial consultation and underwent surgery. The changes in clinical symptoms associated with OPLL in the cervical spine were examined periodically. During the natural course of OPLL in the cervical spine, 37 (22%) of 167 patients developed or suffered aggravated spinal symptoms. All of the patients with a space available for the spinal cord (SAC) less than 6 mm suffered Myelopathy, whereas the patients with an SAC diameter of 14 mm or greater did not. No correlation was found between the presence or absence of Myelopathy in patients whose SAC diameter ranged from 6 mm to less than 14 mm. In patients with...
Hehui Wang - One of the best experts on this subject based on the ideXlab platform.
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anterior corpectomy versus posterior laminoplasty for multilevel cervical Myelopathy a systematic review and meta analysis
European Spine Journal, 2014Co-Authors: Zhilai Zhou, Hehui WangAbstract:Background Surgical strategy for multilevel cervical Myelopathy resulting from cervical spondylotic Myelopathy (CSM) or ossification of posterior longitudinal ligament (OPLL) still remains controversial. There are still questions about the relative benefit and safety of direct decompression by anterior corpectomy (CORP) versus indirect decompression by posterior laminoplasty (LAMP).
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anterior decompression and fusion versus posterior laminoplasty for multilevel cervical compressive Myelopathy
Orthopedics, 2014Co-Authors: Xuzhou Liu, Zhilai Zhou, Hehui Wang, Anmin JinAbstract:Abstract The optimal surgical strategy for anterior or posterior approaches remains controversial for multilevel cervical compressive Myelopathy caused by multisegment cervical spondylotic Myelopathy (MCSM) or ossification of the posterior longitudinal ligament (OPLL). A systematic review and meta-analysis was conducted evaluating the clinical results of anterior decompression and fusion (ADF) compared with posterior laminoplasty for patients with multilevel cervical compressive Myelopathy. PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials and nonrandomized cohort studies conducted from 1990 to May 2013 comparing ADF with posterior laminoplasty for the treatment of multilevel cervical compressive Myelopathy due to MCSM or OPLL. The following outcome measures were extracted: Japanese Orthopedic Association (JOA) score, recovery rate, complication rate, reoperation rate, blood loss, and operative time. Subgroup analysis was conducted according to the mean number of surgical segments. Eleven studies were included in the review, all of which were prospective or retrospective cohort studies with relatively low quality indicated by GRADE Working Group assessment. A definitive conclusion could not be reached regarding which surgical approach is more effective for the treatment of multilevel cervical compressive Myelopathy. Although ADF was associated with better postoperative neural function than posterior laminoplasty in the treatment of multilevel cervical compressive Myelopathy due to MCSM or OPLL, there was no apparent difference in the neural function recovery rate between the 2 approaches. Higher rates of surgery-related complication and reoperation should be taken into consideration when ADF is used for patients with multilevel cervical compressive Myelopathy. The surgical trauma associated with corpectomy was significantly higher than that associated with posterior laminoplasty.
Setsuro Komiya - One of the best experts on this subject based on the ideXlab platform.
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clinical course of patients with ossification of the posterior longitudinal ligament a minimum 10 year cohort study
Journal of Neurosurgery, 2004Co-Authors: Shunji Matsunaga, Takashi Sakou, Eiji Taketomi, Setsuro KomiyaAbstract:Object. Ossification of the posterior longitudinal ligament (OPLL) may produce quadriplegia. The course of future neurological deterioration in patients with radiographic evidence of OPLL, however, is not known. The authors conducted a long-term follow-up cohort study of more than 10 years to clarify the clinical course of this disease progression. Methods. A total of 450 patients, including 304 managed conservatively and 146 treated by surgery, were enrolled in the study. All patients underwent neurological and radiographical follow-up examinations for a mean of 17.6 years. Myelopathy was graded using Nurick classification and the Japanese Orthopaedic Association scale. Fifty-five (17%) of 323 patients without Myelopathy evident at the first examination developed Myelopathy during the follow-up period. Risk factors associated with the evolution of Myelopathy included greater than 60% OPLL-induced stenotic compromise of the cervical canal, and increased range of motion of the cervical spine. Using Kaplan—...
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pathogenesis of Myelopathy in patients with ossification of the posterior longitudinal ligament
Journal of Neurosurgery, 2002Co-Authors: Shunji Matsunaga, Takashi Sakou, Makoto Kukita, Kyoji Hayashi, Reiko Shinkura, Chihaya Koriyama, Setsuro KomiyaAbstract:Object. The goal of this study was to clarify the pathogenesis of Myelopathy in patients with ossification of the posterior longitudinal ligament (OPLL) based on the relationship between static compression factors and dynamic factors. Methods. There was a total of 247 patients, including 167 patients who were conservatively followed for a mean of 11 years and 2 months and 80 patients who had Myelopathy at initial consultation and underwent surgery. The changes in clinical symptoms associated with OPLL in the cervical spine were examined periodically. During the natural course of OPLL in the cervical spine, 37 (22%) of 167 patients developed or suffered aggravated spinal symptoms. All of the patients with a space available for the spinal cord (SAC) less than 6 mm suffered Myelopathy, whereas the patients with an SAC diameter of 14 mm or greater did not. No correlation was found between the presence or absence of Myelopathy in patients whose SAC diameter ranged from 6 mm to less than 14 mm. In patients with...
