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

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Neurosurgery Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
2
Neurosurgery Unit, Poliambulanza Foundation, 24124 Brescia, Italy
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Neurosurgery Unit, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Ospedale di Circolo e Fondazione Macchi, 21100 Varese, Italy
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Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili di Brecia, 25123 Brescia, Italy
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Neurophysiopathology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili di Brecia, 25123 Brescia, Italy
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Center for Neuromuscular Diseases, Unit of Neurology, ASST “Spedali Civili”, 25123 Brescia, Italy
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Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(7), 2197; https://doi.org/10.3390/jcm9072197
Received: 9 May 2020 / Revised: 1 July 2020 / Accepted: 9 July 2020 / Published: 12 July 2020
(This article belongs to the Special Issue Degenerative Cervical Myelopathy and the Aging Spine)
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. View Full-Text
Keywords: snake-eye; owl sign; Hirayama disease; degenerative cervical myelopathy (DCM) snake-eye; owl sign; Hirayama disease; degenerative cervical myelopathy (DCM)
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MDPI and ACS Style

Fontanella, M.M.; Zanin, L.; Bergomi, R.; Fazio, M.; Zattra, C.M.; Agosti, E.; Saraceno, G.; Schembari, S.; De Maria, L.; Quartini, L.; Leggio, U.; Filosto, M.; Gasparotti, R.; Locatelli, D. Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review. J. Clin. Med. 2020, 9, 2197. https://doi.org/10.3390/jcm9072197

AMA Style

Fontanella MM, Zanin L, Bergomi R, Fazio M, Zattra CM, Agosti E, Saraceno G, Schembari S, De Maria L, Quartini L, Leggio U, Filosto M, Gasparotti R, Locatelli D. Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review. Journal of Clinical Medicine. 2020; 9(7):2197. https://doi.org/10.3390/jcm9072197

Chicago/Turabian Style

Fontanella, Marco Maria, 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. 2020. "Snake-Eye Myelopathy and Surgical Prognosis: Case Series and Systematic Literature Review" Journal of Clinical Medicine 9, no. 7: 2197. https://doi.org/10.3390/jcm9072197

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