ABSTRACT
This meta-analysis was designed to elucidate whether preoperative signal intensity changes could predict the surgical outcomes of patients with cervical spondylosis myelopathy on the basis of T1-weighted and T2-weighted magnetic resonance imaging images. We searched the Medline database and the Cochrane Central Register of Controlled Trials for this purpose and 10 studies meeting our inclusion criteria were identified. In total, 650 cervical spondylosis myelopathy patients with (+) or without (-) intramedullary signal changes on their T2-weighted images were examined. Weighted mean differences and 95g% confidence intervals were used to summarize the data. Patients with focal and faint border changes in the intramedullary signal on T2 magnetic resonance imaging had similar Japanese Orthopaedic Association recovery ratios as those with no signal changes on the magnetic resonance imaging images of the spinal cord did. The surgical outcomes were poorer in the patients with both T2 intramedullary signal changes, especially when the signal changes were multisegmental and had a well-defined border and T1 intramedullary signal changes compared with those without intramedullary signal changes. Preoperative magnetic resonance imaging including T1 and T2 imaging can thus be used to predict postoperative recovery in cervical spondylosis myelopathy patients.
Subject(s)
Humans , Magnetic Resonance Imaging/methods , Spinal Cord Diseases/pathology , Spondylosis/pathology , Postoperative Period , Predictive Value of Tests , Prognosis , Preoperative Care/methods , Recovery of Function , Spinal Cord Diseases/rehabilitation , Spinal Cord Diseases/surgery , Spondylosis/rehabilitation , Spondylosis/surgeryABSTRACT
Objective To evaluate of the efficacy of transcranial electrical stimulation motor evoked potential (TES-MEP)in combination with cortical somatosensory evoked potential (CSEP) monitoring during the anterior or posterior approach spinal surgery for cervical spondylitie myelopathy (CSM).Methods TES-MEP on the bilateral anterior tibial muscle and flexor hallucal brevis and thenar muscles and CSEP on the bilateral posterior tibial nerve and ulnar nerve were observed simultaneously in 135 patients during spinal surgery.Intravenous anesthesia was employed in all the patients.The results of TES-MEP,CSEP and combined monitoring were analyzed statistically.Pre-oporative and post-operative motor and sensory functions of the spinal cord were compared. Result Success rate of TES-MEP,CSEP and the combined monitoring was 87.4%.97.8%and 100%,respectively.Out of 135 patients,nine patients (6.7%) were detected with the positive evoked potentials due to surgical operation.The sensitivity of TES-MEP and CSEP in assessing the spinal cord motor function was 100%and 83.3%,respectively,while that in assessing the spinal cord sensory function was 77.8%and 100%,respectively.The sensitivity and specificity of the combined monitoring was both 100%. Conclusion The successful detection rate and accuracy of the combined monitoring for spinal cord function are apparently higher than that of simple TES-MEP or CSEP.The causes for operative maneuvers evoking a positive evoked potential include complete anterior decompression of the spinal canal,intervertebral bone graft,laminoplasty for OPLL and hematoma compression caused by a failed drainage in a posterior-anterior approach surgery.
ABSTRACT
Objective To evaluate the clinical results of expansive cervical laminoplasty by anterior and posterior cervical decompression in the treatment of Cervical Spondylosis Myelopathy with developmental cervical stenosis.Methods Retrospective analyze 32 patients of cervical spondylosis myelopathy treated with expansive cervical laminoplasty by anterior and posterior cervical decompression from Mar 1995 to Aug 2000 years, there were 21 males and 11 females, developmental cervical stenosis (DCS) with cervical intervertebral disc protrusion in 25 cases, with the ossification of cervical posterior longitudinal ligament (OPLL) in 7 cases. Neural functionality (JOA Scoring System), cervical axial symptoms, and pre-and post-surgery dynamic cervical spine lateral x-ray films and cervical vertebra MRI were evaluated. Results 32 cases had been followed up for an average of 24.3 months, with an average age 58.9 years (range 38-72). The average rate of improvement of the third and sixth in month postoperative,the first and third postoperative year was 58.1%,65.9%,69.1% and 68.4% respectively;the excellent and good was 71.9%,81.3%,78.1%,77.3% respectivery. Cervical axial symptoms were reduced. Instability of the cervical spine were not found and decompression was confirmed on MRI. Conclusion Expansive cervical laminoplasty by anterior and posterior cervical decompression in the treatement of cervical spondylosis myelopathy with developmental cervical stenosis have good efficacy and it is a stable operative method.