#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Cord compression defined by MRI is the driving factor behind the decision to operate in Degenerative Cervical Myelopathy despite poor correlation with disease severity


Autoři: Bryn Hilton aff001;  Jennifer Tempest-Mitchell aff001;  Benjamin M. Davies aff002;  Jibin Francis aff002;  Richard J. Mannion aff002;  Rikin Trivedi aff002;  Ivan Timofeev aff002;  John R. Crawford aff002;  Douglas Hay aff002;  Rodney J. Laing aff002;  Peter J. Hutchinson aff002;  Mark R. N. Kotter aff002
Působiště autorů: School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom aff001;  Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom aff002
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226020

Souhrn

Objectives

The mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM.

Study design

Retrospective cohort study.

Methods

1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations.

Results

Of the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant.

Conclusions

Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.

Klíčová slova:

Decision making – Lesions – Magnetic resonance imaging – Spine – Surgeons – Surgical and invasive medical procedures – Treatment guidelines


Zdroje

1. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative Cervical Myelopathy: Epidemiology, Genetics, and Pathogenesis. Spine (Phila Pa 1976). 2015 Jun 15;40(12):E675–93

2. Davies BM, Mowforth OD, Smith EK, Kotter MR. Degenerative cervical myelopathy. BMJ. 2018 Feb 22;360:k186 doi: 10.1136/bmj.k186 29472200

3. Kovalova I, Kerkovsky M, Kadanka Z, et al. Prevalence and Imaging Characteristics of Nonmyelopathic and Myelopathic Spondylotic Cervical Cord Compression. Spine (Phila Pa 1976). 2016 Dec 15;41(24):1908–1916.

4. Kadanka Z Jr, Adamova B, Kerkovsky M, et al. Predictors of symptomatic myelopathy in degenerative cervical spinal cord compression. Brain Behav. 2017 Aug 11;7(9):e00797 doi: 10.1002/brb3.797 28948090

5. de Oliveira Vilaça C, Orsini M, Leite MA, de Freitas MR, Davidovich E, Fiorelli R, Fiorelli S, Fiorelli C, Oliveira AB, Pessoa BL. Cervical Spondylotic Myelopathy: What the Neurologist Should Know. Neurol Int. 2016 Nov 23;8(4):6330 doi: 10.4081/ni.2016.6330 27994827

6. Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, et al.: The natural history of cervical spondylotic myelopathy. J Neurosurg Spine. 2009 Aug;11(2):104–11. doi: 10.3171/2009.1.SPINE08716 19769489

7. King JTJ, McGinnis KA, Roberts MS. Quality of Life Assessment with the Medical Outcomes Study Short Form-36 among Patients with Cervical Spondylotic Myelopathy. Neurosurgery. 2003 Jan 1;52(1):113. doi: 10.1097/00006123-200301000-00014 12493107

8. Hilton B, Tempest-Mitchell J, Davies B, Kotter M. Route to diagnosis of degenerative cervical myelopathy in a UK healthcare system: a retrospective cohort study. BMJ Open. 2019 May 5;9(5):e027000. doi: 10.1136/bmjopen-2018-027000 31061045

9. Hilton B, Tempest-Mitchell J, Davies B, Kotter M. Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes. PLoS One. 2018 Dec 17;13(12):e0207709. doi: 10.1371/journal.pone.0207709 30557368

10. Bakhsheshian J, Mehta VA, Liu JC. Current Diagnosis and Management of Cervical Spondylotic Myelopathy. Global Spine J. 2017 Sep;7(6):572–586. doi: 10.1177/2192568217699208 28894688

11. Tetreault L, Kopjar B, Côté P, Arnold P, Fehlings MG. A Clinical Prediction Rule for Functional Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International Prospective Multicenter Data Set of 757 Subjects. J Bone Joint Surg Am. 2015 Dec 16;97(24):2038–46 doi: 10.2106/JBJS.O.00189 26677238

12. Matz PG, Anderson PA, Groff MW, et al. Cervical laminoplasty for the treatment of cervical degenerative myelopathy. J Neurosurg Spine 11:157–169, 2009 doi: 10.3171/2009.1.SPINE08726 19769495

13. Holly LT, Matz PG, Anderson PA, et al. Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy. J Neurosurg Spine 11:112–118, 2009 doi: 10.3171/2009.1.SPINE08718 19769490

14. Zhang JT, Wang LF, Wang S, Li J, Shen Y. Risk factors for poor outcome of surgery for cervical spondylotic myelopathy. Spinal Cord. 2016 Dec;54(12):1127–1131 doi: 10.1038/sc.2016.64 27137121

15. Nouri A, Tetreault L, Côté P, Zamorano JJ, Dalzell K, Fehlings MG. Does Magnetic Resonance Imaging Improve the Predictive Performance of a Validated Clinical Prediction Rule Developed to Evaluate Surgical Outcome in Patients With Degenerative Cervical Myelopathy? Spine (Phila Pa 1976). 2015 Jul 15;40(14):1092–100.

16. Nouri A, Martin AR, Nater A, et al. Influence of Magnetic Resonance Imaging Features on Surgical Decision-Making in Degenerative Cervical Myelopathy: Results from a Global Survey of AOSpine International Members. World Neurosurg. 2017 Sep;105:864–874. doi: 10.1016/j.wneu.2017.06.025 28625905

17. Tetreault L, Palubiski LM, Kryshtalskyj M, et al. Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy: A Systematic Review of the Literature. Neurosurg Clin N Am. 2018 Jan;29(1):115–127 doi: 10.1016/j.nec.2017.09.020 29173423

18. Fehlings MG, Tetreault L, Riew K, et al. A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression. Global Spine Journal. 2017 Sept. 7(3_suppl), 70S–83S.

19. Tempest-Mitchell J, Hilton B, Davies BM, Nouri A, Hutchinson PJ, Scoffings DJ, Mannion RJ, Trivedi R, Timofeev I, Crawford JR, Hay D, Laing RJ, Kotter MRN. A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management. PLoS One. 2019 Jul 22;14(7):e0219380. doi: 10.1371/journal.pone.0219380 31329621

20. Fehlings M. G. et al. (1999) ‘The optimal radiologic method for assessing spinal canal compromise and cord compression in patients with cervical spinal cord injury. Part II: Results of a multicenter study.’, Spine, 24(6), pp. 605–13. doi: 10.1097/00007632-199903150-00023 10101829

21. Nouri A, Martin AR, Mikulis D, Fehlings MG. Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques. Neurosurg Focus. 2016;40:E5.

22. Shin J. J. et al. (2010) ‘Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy’, Acta Neurochirurgica, 152(10), pp. 1687–1694. doi: 10.1007/s00701-010-0692-8 20512384

23. Witiw C, Mathieu F, Nouri A, Fehlings MG. Clinico-Radiographic Discordance: An Evidence-Based Commentary on the Management of Degenerative Cervical Spinal Cord Compression in the Absence of Symptoms or With Only Mild Symptoms of Myelopathy. Global Spine J. 1–8, 2017.

24. Bednarik J, Kadanka Z, Dusek L, et al. Presymptomatic spondyloticcervical myelopathy: an updated predictive model. Eur Spine J. 2008;17:421–431.

25. Nagata K, Yoshimura N, Muraki S, et al. Prevalence of cervical cord compression and its association with physical performance in a population-based cohort in Japan: the Wakayama Spine Study. Spine (Phila Pa 1976). 2012 Oct 15;37(22):1892–8.

26. Nemani VM, Kim HJ, Piyaskulkaew C, Nguyen JT, Riew KD. Correlation of cord signal change with physical examination findings in patients with cervical myelopathy. Spine (Phila Pa 1976). 2015 Jan 1;40(1):6–10

27. Rhee JM, Heflin JA, Hamasaki T, et al. Prevalence of physical signs in cervical myelopathy: a prospective, controlled study. Spine (Phila Pa 1976) 2009;34:890–5.

28. Kovalova I, Kerkovsky M, Kadanka Z, et al. Prevalence and Imaging Characteristics of Nonmyelopathic and Myelopathic Spondylotic Cervical Cord Compression. Spine (Phila Pa 1976). 2016 Dec 15;41(24):1908–1916.

29. Kimura S, Hesselink JR, Garfin SR, Kawaji Y, Hasegawa K, Hargens AR. Axial load-dependent cervical spinal alterations during simulated upright posture: a comparison of healthy controls and patients with cervical degenerative disease. J Neurosurg Spine. 2005 Feb;2(2):137–44. doi: 10.3171/spi.2005.2.2.0137 15739524

30. Zeitoun D, El Hajj F, Sariali E, Catonné Y, Pascal-Moussellard H. Evaluation of spinal cord compression and hyperintense intramedullary lesions on T2-weighted sequences in patients with cervical spondylotic myelopathy using flexion-extension MRI protocol. Spine J. 2015 Apr 1;15(4):668–74. doi: 10.1016/j.spinee.2014.12.001 25485484

31. Bartlett RJ, Rigby AS, Joseph J, Raman A, Kunnacherry A, Hill CA. Extension MRI is clinically useful in cervical myelopathy. Neuroradiology. 2013 Sep;55(9):1081–8. doi: 10.1007/s00234-013-1208-z 23740097

32. Kim CH, Chung CK, Kim KJ, et al. Cervical extension magnetic resonance imaging in evaluating cervical spondylotic myelopathy. Acta Neurochir (Wien). 2014 Feb;156(2):259–66. doi: 10.1007/s00701-013-1951-2 24287683

33. Uchida K, Nakajima H, Okazawa H, et al. Clinical significance of MRI/(18)F-FDG PET fusion imaging of the spinal cord in patients with cervical compressive myelopathy. Eur J Nucl Med Mol Imaging. 2012 Oct;39(10):1528–37. doi: 10.1007/s00259-012-2192-y 22854985

34. Floeth FW1, Stoffels G, Herdmann J, et al. Prognostic value of 18F-FDG PET in monosegmental stenosis and myelopathy of the cervical spinal cord. J Nucl Med. 2011 Sep;52(9):1385–91 doi: 10.2967/jnumed.111.091801 21852356

35. Ellingson BM, Salamon N, Holly LT. Advances in MR imaging for cervical spondylotic myelopathy. Eur Spine J. 2015 Apr;24 Suppl 2:197–208.

36. Tetreault L, Palubiski LM, Kryshtalskyj M, et al. Significant Predictors of Outcome Following Surgery for the Treatment of Degenerative Cervical Myelopathy: A Systematic Review of the Literature. Neurosurg Clin N Am. 2018 Jan;29(1):115–127 doi: 10.1016/j.nec.2017.09.020 29173423

37. Meshikhes AW. Evidence-based surgery: The obstacles and solutions. Int J Surg. 2015 Jun;18:159–62 doi: 10.1016/j.ijsu.2015.04.071 25934416

38. Mowforth O, Davies BM, Goh S, O’Neill CP, Kotter MRN. Research Inefficiency in Degenerative Cervical Myelopathy: Findings of a Systematic Review on Research Activity Over the Past 20 Years. Global Spine Journal. June 2019.


Článek vyšel v časopise

PLOS One


2019 Číslo 12
Nejčtenější tento týden
Nejčtenější v tomto čísle
Kurzy

Zvyšte si kvalifikaci online z pohodlí domova

KOST
Koncepce osteologické péče pro gynekology a praktické lékaře
nový kurz
Autoři: MUDr. František Šenk

Sekvenční léčba schizofrenie
Autoři: MUDr. Jana Hořínková

Hypertenze a hypercholesterolémie – synergický efekt léčby
Autoři: prof. MUDr. Hana Rosolová, DrSc.

Svět praktické medicíny 5/2023 (znalostní test z časopisu)

Imunopatologie? … a co my s tím???
Autoři: doc. MUDr. Helena Lahoda Brodská, Ph.D.

Všechny kurzy
Kurzy Podcasty Doporučená témata Časopisy
Přihlášení
Zapomenuté heslo

Zadejte e-mailovou adresu, se kterou jste vytvářel(a) účet, budou Vám na ni zaslány informace k nastavení nového hesla.

Přihlášení

Nemáte účet?  Registrujte se

#ADS_BOTTOM_SCRIPTS#