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Degenerative Cervical Myelopathy and the Aging Spine

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (1 February 2020) | Viewed by 46528

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Special Issue Editors

Dr. Aria Nouri

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Guest Editor

Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
Interests: Degenerative Cervical Myelopathy (DCM); Magnetic Resonance Imaging (MRI); cervical canal stenosis; Subacute Combined Degeneration of the Spinal Cord (SACD); anemia and DCM; cervical spine surgery; surgical decision-making; surgical outcome prediction; Ossification of the Posterior Longitudinal Ligament (OPLL); cervical spondylolithesis
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Prof. Dr. Enrico Tessitore

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Guest Editor

Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
Interests: degenerative cervical myelopathy; the aging spine
Special Issues, Collections and Topics in MDPI journals

Dr. Mark R. Kotter

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Guest Editor

Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
Interests: cervical myelopathy; spinal cord injury; stem cells; cellular reprogramming

Dr. Joseph Cheng

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Guest Editor

Chair, Department of Neurosurgery, University of Cincinnati, Cincinnati, OH, USA
Interests: health outcomes and policy; spinal biomechanics; cervical myelopathy; spinal deformity

Special Issue Information

Dear Colleagues,

As many of you already know, Degenerative Cervical Myelopathy (DCM) is the most common cause of spinal cord impairment in the developed world, leading not only to a decrease in the quality of life of those affected but also to a growing healthcare burden. Over the past few years, a number of multicentre studies on the topic have emerged, helping to provide a better understanding of the condition. However, it is also clear that much remains to be learned. This is evidenced by the fact that the term DCM was only formally introduced in 2015, guidelines on DCM based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) process were published in 2017, and, at the present time, an active effort called RECODE-DCM (Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy) is underway that aims to shape the way future DCM research is carried out. With this Special Issue, we hope to encourage submissions that discuss the current state-of-the-art, address ongoing knowledge gaps, and focus on ongoing controversies related to Degenerative Cervical Myelopathy and the management of the aging spine.

We look forward to receiving your submission.

Dr. Aria Nouri
Dr. Enrico Tessitore
Dr. Mark R. Kotter
Dr. Joseph Cheng
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Degenerative cervical myelopathy (DCM)
Imaging of the cervical spine
Cervical canal stenosis
Cervical spine surgery
Surgical outcome prediction
Ossification of the posterior longitudinal ligament (OPLL)
Cervical spondylolisthesis
Cervical deformity
Spinal cord compression

Published Papers (13 papers)

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Editorial

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7 pages, 179 KiB

Open AccessEditorial

Degenerative Cervical Myelopathy and the Aging Spine: Introduction to the Special Issue

by Aria Nouri, Renato Gondar, Joseph S. Cheng, Mark R.N. Kotter and Enrico Tessitore

J. Clin. Med. 2020, 9(8), 2535; https://doi.org/10.3390/jcm9082535 - 06 Aug 2020

Cited by 7 | Viewed by 1970

Abstract

Degenerative Cervical Myelopathy (DCM) is the most common cause of spinal cord injury in the world, but despite this, there remains many areas of uncertainty regarding the management of the condition. This special issue was dedicated to presenting current research topics in DCM. Within this issue, 12 publications are presented, including an introductory narrative overview of DCM and 11 articles comprising 9 research papers and 2 systematic reviews focusing on different aspects, ranging from genetic factors to clinical assessments, imaging, sagittal balance, surgical treatment, and outcome prediction. These articles represented contributions from a diverse group of researchers coming from multiple countries, including Switzerland, Germany, Italy, United Kingdom, United States, South Korea, and Canada. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

Research

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11 pages, 2909 KiB

Open AccessArticle

The Functional Relevance of Diffusion Tensor Imaging in Patients with Degenerative Cervical Myelopathy

by Stefania d’Avanzo, Marco Ciavarro, Luigi Pavone, Gabriele Pasqua, Francesco Ricciardi, Marcello Bartolo, Domenico Solari, Teresa Somma, Oreste de Divitiis, Paolo Cappabianca and Gualtiero Innocenzi

J. Clin. Med. 2020, 9(6), 1828; https://doi.org/10.3390/jcm9061828 - 11 Jun 2020

Cited by 12 | Viewed by 2289

Abstract

(1) Background: In addition to conventional magnetic resonance imaging (MRI), diffusion tensor imaging (DTI) has been investigated as a potential diagnostic and predictive tool for patients with degenerative cervical myelopathy (DCM). In this preliminary study, we evaluated the use of quantitative DTI in the clinical practice as a possible measure to correlate with upper limbs function. (2) Methods: A total of 11 patients were enrolled in this prospective observational study. Fractional anisotropy (FA) values was extracted from DTI data before and after surgery using a GE Signa 1.5 T MRI scanner. The Nine-Hole Peg Test and a digital dynamometer were used to measure dexterity and hand strength, respectively. (3) Results: We found a significant increase of FA values after surgery, in particular below the most compressed level (p = 0.044) as well as an improvement in postoperative dexterity and hand strength. Postoperative FA values moderately correlate with hand dexterity (r = 0.4272, R₂ = 0.0735, p = 0.19 for the right hand; r = 0.2087, R₂ = 0.2265, p = 0.53 for the left hand). (4) Conclusion: FA may be used as a marker of myelopathy and could represent a promising diagnostic value in patients affected by DCM. Surgical decompression can improve the clinical outcome of these patients, especially in terms of the control of finger-hand coordination and dexterity. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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11 pages, 1242 KiB

Open AccessArticle

Cervical Myelopathy in Patients Suffering from Rheumatoid Arthritis—A Case Series of 9 Patients and A Review of the Literature

by Insa Janssen, Aria Nouri, Enrico Tessitore and Bernhard Meyer

J. Clin. Med. 2020, 9(3), 811; https://doi.org/10.3390/jcm9030811 - 17 Mar 2020

Cited by 11 | Viewed by 4878

Abstract

Cervical myelopathy occurs in approximately 2.5% of patients suffering from rheumatoid arthritis (RA) and is associated with notable morbidity and mortality. However, the surgical management of patients affected by cervical involvement in the setting of RA remains challenging and not well studied. To address this, we conducted a retrospective analysis of our clinical database between May 2007 and April 2017, and report on nine patients suffering from cervical myelopathy due to RA. We included patients treated surgically for cervical myelopathy on the basis of diagnosed RA. Clinical findings, treatment and outcome were assessed and reported. In addition, we conducted a narrative review of the literature. Four patients were male. Mean age was 64.8 ± 20.5 years. Underlying cervical pathology was anterior atlantoaxial instability (AAI) associated with retrodental pannus in four cases, anterior atlantoaxial subluxation (AAS) in two cases and basilar invagination in three cases. All patients received surgical treatment via posterior fixation, and in addition two of these cases were combined with a transnasal approach. Preoperative modified Japanese orthopaedic association scale (mJOA) improved from 12 ± 2.4 to 14.6 ± 1.89 at a mean follow-up at 18.8 ± 23.3 months (range 3–60 months) in five patients. In four patients, no follow up was available, and the mJOA of these patients at time of discharge was stable compared to the preoperative score. One patient died two days after surgery, where a pulmonary embolism was assumed to be the cause of mortality, and one patient sustained a temporary worsening of his neurological deficit postoperatively. Surgery is generally an effective treatment method in patients with inflammatory arthropathies of the cervical spine. Given the nature of the RA and potential instability, fixation in addition to cord decompression is generally required. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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12 pages, 1947 KiB

Open AccessArticle

Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

by Rocco Severino, Aria Nouri and Enrico Tessitore

J. Clin. Med. 2020, 9(3), 759; https://doi.org/10.3390/jcm9030759 - 11 Mar 2020

Cited by 14 | Viewed by 2772

Abstract

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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11 pages, 853 KiB

Open AccessArticle

Quantitative Assessment of Gait Characteristics in Degenerative Cervical Myelopathy: A Prospective Clinical Study

by Sukhvinder Kalsi-Ryan, Anna C. Rienmueller, Lauren Riehm, Colin Chan, Daniel Jin, Allan R. Martin, Jetan H. Badhiwala, Muhammad A. Akbar, Eric M. Massicotte and Michael G. Fehlings

J. Clin. Med. 2020, 9(3), 752; https://doi.org/10.3390/jcm9030752 - 10 Mar 2020

Cited by 20 | Viewed by 3367

Abstract

It is challenging to discriminate the early presentation of Degenerative Cervical Myelopathy (DCM) as well as sensitively and accurately distinguishing between mild, moderate, and severe levels of impairment. As gait dysfunction is one of the cardinal symptoms of DCM, we hypothesized that spatiotemporal gait parameters, including the enhanced gait variability index (eGVI), could be used to sensitively discriminate between different severities of DCM. A total of 153 patients recently diagnosed with DCM were recruited and stratified on the basis of DCM severity grades, as measured using the modified Japanese Orthopedic Association (mJOA) scale. Demographic information and neurological status were collected. Gait assessments were performed using an 8 m walkway. Spearman rank correlation was used to identify relationships between gait parameters and mJOA values as well as the mJOA lower extremity (LE) subscore. Kruskal–Wallis H test was performed to evaluate differences between severity groups, as defined by mJOA classification. A significant and relatively strong correlation was found between the mJOA score and eGVI, as well as between the LE subscore of the mJOA and eGVI. Significant differences in the eGVI (X²(2, N = 153) = 55.04, p < 0.0001, ε2 = 0.36) were found between all groups of DCM severity, with a significant increase in the eGVI as DCM progressed from mild to moderate. The eGVI was the most discriminative gait parameter, which facilitated objective differentiation between varying severities of DCM. Quantitative gait assessments show promise as an accurate and objective tool to diagnose and classify DCM, as well as to potentially evaluate the impact of therapeutic interventions. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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17 pages, 13162 KiB

Open AccessArticle

Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

by Seok Woo Kim, Seung Bo Jang, Hyung Min Lee, Jeong Hwan Lee, Min Uk Lee, Jeong Woo Kim and Jae Sung Yee

J. Clin. Med. 2020, 9(3), 713; https://doi.org/10.3390/jcm9030713 - 05 Mar 2020

Cited by 13 | Viewed by 4110

Abstract

For patients with kyphosis of the cervical spine, laminoplasty is usually incapable of improving neurological symptoms as it worsens kyphotic alignment. Thus, laminoplasty is not recommended in the presence of kyphotic alignment. Nevertheless, laminoplasty may be selected for myelopathy due to multiple-segment intervertebral disc herniation or ossification of posterior longitudinal ligament despite kyphotic alignment. This study examined whether cervical alignment influences surgical outcomes. Cervical alignment before the surgery was classified into lordosis and non-lordosis, and the non-lordosis group was subclassified into reducible and non-reducible groups to determine the change in cervical alignment before and after the surgery and to analyze its relationship with spinopelvic parameters. The lordosis group showed an increase in upper cervical motion (C0-2 Range of Motion (ROM), C0-2ROM/C0-7ROM) after surgery, while the non-lordosis group exhibited a decrease in C2-7ROM and C0-7ROM. The C0-2ROM was maintained without any reduction in the reducible group, while there was no significant change in cervical alignment and ROM of the non-reducible group. None of these changes showed significant association with the spinopelvic parameters of other sites. However, having a non-reducible type non-lordosis is not a proper indication for laminoplasty, as it does not change the alignment after surgery. Therefore, cervical alignment and reducibility should be identified before surgery. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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9 pages, 244 KiB

Open AccessArticle

The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

by Aria Nouri, Jetan H. Badhiwala, So Kato, Hamed Reihani-Kermani, Kishan Patel, Jefferson R. Wilson, Insa Janssen, Joseph S. Cheng, Karl Schaller, Enrico Tessitore and Michael G. Fehlings

J. Clin. Med. 2020, 9(3), 624; https://doi.org/10.3390/jcm9030624 - 26 Feb 2020

Cited by 11 | Viewed by 2559

Abstract

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (GICs) commonly occur in this group; however, their relationship with DCM has not been thoroughly investigated. It is the objective of the present study to investigate the difference between patients with or without GICs who are surgically treated for DCM. A cohort of 757 patients with clinical data and 458 with magnetic resonance imaging (MRI) data from the AOSpine North America and AOSpine International studies on DCM was evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic, and pancreatic conditions. Patients were dichotomized into 2 groups: those with GICs and those without GICs. Both clinical and MRI presentation, as well as baseline neurological and functional status, were compared. Neurological and functional outcomes at 2-year follow-up were also compared. GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs. 65.4%, p = 0.001) and were slightly less neurologically impaired based on the Nurick grade (3.05 ± 1.10 vs. 3.28 ± 1.16, p = 0.044) but not based on mJOA (12.74 ± 2.62 vs. 12.48 ± 2.76, p = 0.33). They also had a worse physical health score (32.80 ± 8.79 vs. 34.65 ± 9.38 p = 0.049), worse neck disability (46.31 ± 20.04 vs. 38.23 ± 20.44, p < 0.001), a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs. 78.9%, p = 0.037; Babinski’s sign 24.8% vs. 37.3%, p = 0.008), and a higher rate of psychiatric comorbidities (31.4% vs. 10.4%, p < 0.0001). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs. 75.6%, p < 0.001; T1 hypointensity, 9.7% vs. 21.1%, p = 0.036), and had a lower number of T2 hyperintensity levels (0.82 ± 0.98 vs. 1.3 ± 1.11, p = 0.001). There was no difference in surgical outcome between the groups. DCM patients with GICs are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have less clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in DCM, and it is therefore plausible that nutritional factors may contribute to this unique observation. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

12 pages, 1134 KiB

Open AccessArticle

Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery?

by Oliver Gembruch, Ramazan Jabbarli, Ali Rashidi, Mehdi Chihi, Nicolai El Hindy, Axel Wetter, Bernd-Otto Hütter, Ulrich Sure, Philipp Dammann and Neriman Özkan

J. Clin. Med. 2020, 9(1), 62; https://doi.org/10.3390/jcm9010062 - 26 Dec 2019

Cited by 18 | Viewed by 2958

Abstract

Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age. Full article

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11 pages, 231 KiB

Open AccessFeature PaperArticle

The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies

by Jamie R. F. Wilson, Jetan H. Badhiwala, Fan Jiang, Jefferson R. Wilson, Branko Kopjar, Alexander R. Vaccaro and Michael G. Fehlings

J. Clin. Med. 2019, 8(10), 1708; https://doi.org/10.3390/jcm8101708 - 17 Oct 2019

Cited by 18 | Viewed by 2857

Abstract

Background: The effect on functional and quality of life (QOL) outcomes of surgery in elderly degenerative cervical myelopathy (DCM) patients has not been definitively established. Objective: To evaluate the effect of older age on the functional and QOL outcomes after surgery in an international, multi-center cohort of patients with DCM. Methods: 107 patients aged over 70 years old (mean 75.6 ± 4.4 years) were enrolled in the AOSpine CSM-North America and International studies. A propensity-matched cohort of 107 patients was generated from the remaining 650 adults aged <70 years old (mean 56.3 ± 9.6 years), matched to gender, complexity of surgery, co-morbidities, and baseline functional impairment (modified Japanese Orthopedic Association scale (mJOA). Functional, disability, and QOL outcomes were compared at baseline and at two years post-operatively, along with peri-operative adverse events. Results: Both cohorts were equivalently matched. At two years, both cohorts showed significant functional improvement from the baseline but the magnitude was greater in the younger cohort (mJOA 3.8 (3.2–4.4) vs. 2.6 (2.0–3.3); p = 0.007). This difference between groups was also observed in the SF-36 physical component summary (PCS) and mental component summary (MCS) outcomes (p = <0.001, p = 0.007), but not present in the neck disability index (NDI) scores (p = 0.094). Adverse events were non-significantly higher in the elderly cohort (22.4% vs. 15%; p = 0.161). Conclusions: Elderly patients showed an improvement in functional and QOL outcomes after surgery for DCM, but the magnitude of improvement was less when compared to the matched younger adult cohort. An age over 70 was not associated with an increased risk of adverse events. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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Open AccessArticle

Validating the Transformation of PROMIS-GH to EQ-5D in Adult Spine Patients

by Shreyas Panchagnula, Xin Sun, Julio D. Montejo, Aria Nouri, Luis Kolb, Justin Virojanapa, Joaquin Q. Camara-Quintana, Samuel Sommaruga, Kishan Patel, Nikita Lakomkin, Khalid Abbed and Joseph S. Cheng

J. Clin. Med. 2019, 8(10), 1506; https://doi.org/10.3390/jcm8101506 - 20 Sep 2019

Cited by 4 | Viewed by 2548

Abstract

Spinal disorders and associated interventions are costly in the United States, putting them in the limelight of economic analyses. The Patient-Reported Outcomes Measurement Information System Global Health Survey (PROMIS-GHS) requires mapping to other surveys for economic investigation. Previous studies have proposed transformations of PROMIS-GHS to EuroQol 5-Dimension (EQ-5D) health index scores. These models require validation in adult spine patients. In our study, PROMIS-GHS and EQ-5D were randomly administered to 121 adult spine patients. The actual health index scores were calculated from the EQ-5D instrument and estimated scores were calculated from the PROMIS-GHS responses with six models. Goodness-of-fit for each model was determined using the coefficient of determination (R²), mean squared error (MSE), and mean absolute error (MAE). Among the models, the model treating the eight PROMIS-GHS items as categorical variables (CAT_Reg) was the optimal model with the highest R² (0.59) and lowest MSE (0.02) and MAE (0.11) in our spine sample population. Subgroup analysis showed good predictions of the mean EQ-5D by gender, age groups, education levels, etc. The transformation from PROMIS-GHS to EQ-5D had a high accuracy of mean estimate on a group level, but not at the individual level. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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Review

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Open AccessReview

Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review

by Marco Maria Fontanella, Luca Zanin, Riccardo Bergomi, Marco Fazio, Costanza Maria Zattra, Edoardo Agosti, Giorgio Saraceno, Silvia Schembari, Lucio De Maria, Luisa Quartini, Ugo Leggio, Massimiliano Filosto, Roberto Gasparotti and Davide Locatelli

J. Clin. Med. 2020, 9(7), 2197; https://doi.org/10.3390/jcm9072197 - 12 Jul 2020

Cited by 8 | Viewed by 4072

Abstract

The prognostic value of “snake-eyes” sign in spinal cord magnetic resonance imaging (MRI) is unclear and the correlation with different pathological conditions has not been completely elucidated. In addition, its influence on surgical outcome has not been investigated in depth. A literature review according to PRISMA (Preferred reporting items for systematic review and meta-analysis protocols) guidelines on the prognostic significance of “snake-eyes” sign in operated patients was performed. Clinical, neuroradiological, and surgical data of three institutional patients, were also retrospectively collected. The three patients, with radiological evidence of “snake-eyes” myelopathy, underwent appropriate surgical treatment for their condition, with no new post-operative neurological deficits and good outcome at follow-up. The literature review, however, reported conflicting results: the presence of “snake-eyes” sign seems a poor prognostic factor in degenerative cervical myelopathy, even if some cases can improve after surgery. “Snake-eyes” myelopathy represents a rare form of myelopathy; pathophysiology is still unclear. The frequency of this myelopathy may be greater than previously thought and according to our literature review it is mostly a negative prognostic factor. However, from our experience, prognosis might not be so dire, especially when tailored surgical intervention is performed; therefore, surgery should always be considered and based on the complete clinical, neurophysiological, and radiological data. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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11 pages, 579 KiB

Open AccessReview

Degenerative Cervical Myelopathy: A Brief Review of Past Perspectives, Present Developments, and Future Directions

by Aria Nouri, Joseph S. Cheng, Benjamin Davies, Mark Kotter, Karl Schaller and Enrico Tessitore

J. Clin. Med. 2020, 9(2), 535; https://doi.org/10.3390/jcm9020535 - 16 Feb 2020

Cited by 50 | Viewed by 7604

Abstract

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord injury in developed countries; its prevalence is increasing due to the ageing of the population. DCM causes neurological dysfunction and is a significant cause of disability in the elderly. It has important negative impacts on the quality of life of those affected, as well as on their caregivers. DCM is triggered by a variety of degenerative changes in the neck, which affect one or more anatomical structures, including intervertebral discs, vertebrae, and spinal canal ligaments. These changes can also lead to structural abnormalities, leading to alterations in alignment, mobility, and stability. The principle unifying problem in this disease, regardless of the types of changes present, is injury to the spinal cord due to compression by static and/or dynamic forces. This review is partitioned into three segments that focus on key elements of the past, the present, and the future in the field, which serve to introduce the focus issue on “Degenerative Cervical Myelopathy and the Aging Spine”. Emerging from this review is that tremendous progress has been made in the field, particularly in recent years, and that there are exciting possibilities for further advancements of patient care. Full article

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30 pages, 1588 KiB

Open AccessReview

Genetics of Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis of Candidate Gene Studies

by Daniel H. Pope, Benjamin M. Davies, Oliver D. Mowforth, A. Ramsay Bowden and Mark R. N. Kotter

J. Clin. Med. 2020, 9(1), 282; https://doi.org/10.3390/jcm9010282 - 20 Jan 2020

Cited by 25 | Viewed by 3432

Abstract

Degenerative cervical myelopathy (DCM) is estimated to be the most common cause of adult spinal cord impairment. Evidence that is suggestive of a genetic basis to DCM has been increasing over the last decade. A systematic search was conducted in MEDLINE, EMBASE, Cochrane, and HuGENet databases from their origin up to 14th December 2019 to evaluate the role of single genes in DCM in its onset, clinical phenotype, and response to surgical intervention. The initial search yielded 914 articles, with 39 articles being identified as eligible after screening. We distinguish between those contributing to spinal column deterioration and those contributing to spinal cord deterioration in assessing the evidence of genetic contributions to DCM. Evidence regarding a total of 28 candidate genes was identified. Of these, 22 were found to have an effect on the radiological onset of spinal column disease, while 12 genes had an effect on clinical onset of spinal cord disease. Polymorphisms of eight genes were found to have an effect on the radiological severity of DCM, while three genes had an effect on clinical severity. Polymorphisms of six genes were found to have an effect on clinical response to surgery in spinal cord disease. There are clear genetic effects on the development of spinal pathology, the central nervous system (CNS) response to bony pathology, the severity of both bony and cord pathology, and the subsequent response to surgical intervention. Work to disentangle the mechanisms by which the genes that are reviewed here exert their effects, as well as improved quality of evidence across diverse populations is required for further investigating the genetic contribution to DCM. Full article

(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)

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