Neural Cell Adhesion Molecule (NCAM) a Serum Biomarker Indicative for the Severity of Cervical Spondylotic Myelopathy.

STUDY DESIGN: Peripheral blood samples were obtained from 25 patients with cervical spondylotic myelopathy (CSM) and 13 healthy volunteers. OBJECTIVES: Our aim was to investigate the significance of neurodegenerative biomarkers in patients with CSM and correlate their expression with CSM severity. SUMMARY OF BACKGROUND DATA: CSM is a common disorder involving chronic progressive compression of the cervical spinal resulting in progressive neurological impairment that ranges from mild tingling in the upper limbs to complete quadriplegia. However, the immunological background related to the neurodegenerative damage and its significance in CSM is still unclear. METHODS: Protein expression profiles of 14 neurodegenerative biomarkers were measured by multiplex Luminex bead assay and further analyzed by group comparison statistics, correlation studies, and receiver-operating characteristic analysis. RESULTS: Eleven of 14 biomarkers were significantly elevated in CSM patients as compared with healthy subjects (P<0.05). Specifically, the clinical severity of CSM on the scales of Nurick and modified Japanese Orthopedics Association scale (mJOA) was inversely related to neural cell adhesion molecule (NCAM) levels (r=-0.529, P=0.007; r=-0.519, P=0.001, respectively). CONCLUSIONS: Serum level of neural cell adhesion molecule may serve as a diagnostic biomarker correlating with the severity of CSM.

Plasma VDBP, 25(OH)D, and GSH levels predict surgical outcome in patients with cervical spondylotic myelopathy.

This study intends to investigate the predictive values of plasma Vitamin D-binding protein (VDBP), 25-hydroxyvitamin D [25(OH)D], and glutathione (GSH) levels in the outcome of cervical spondylotic myelopathy (CSM) surgery. Surgery outcomes of 236 CSM patients were determined. Recovery rate was calculated according to Japanese Orthopaedic Association (JOA) scores during follow-up. CSM patients with a recovery rate >50% were assigned with good prognosis and the rest were with fair prognosis. Preoperative and postoperative neurologic function scores were compared among groups. Plasma VDBP and 25(OH)D levels, as well as GSH levels were measured by ELISA and glutathione reductase recycling assay, respectively. Pearson's correlation coefficient was performed to analyze the correlation among plasma VDBP, 25(OH)D, and GSH levels. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of plasma VDBP, 25(OH)D, and GSH levels for surgical outcome. Logistic regression model was used to analyze risk factors for surgical outcome. Compared with those with fair prognosis, CSM patients with good prognosis group exhibited higher postoperative neurologic function scores, plasma VDBP, 25(OH)D, and GSH levels, and better improvements in spinal cord compression and motions of the cervical vertebra. Plasma VDBP, 25(OH)D, and GSH levels were favorable prognostic factors for CSM surgical outcome. The sensitivity and specificity of plasma VDBP, plasma 25(OH)D, and plasma GSH were 89.8% and 91.7%, 85.8% and 84.4%, and 79.5% and 91.7%, respectively. Our study provides evidence that higher plasma VDBP, 25(OH)D, and GSH levels may predict better surgical outcome in CSM patients.

Vitamin D status in cervical spondylotic myelopathy: comparison of fusion rates and patient outcome measures.

BACKGROUND: Patients undergoing elective spinal fusion have an alarming rate of vitamin D deficiency, but its impact on bone fusion and patient outcomes is unclear. We investigated the association of perioperative vitamin D levels, fusion rates, and patient-reported outcome in patients undergoing spinal fusion for cervical spondylotic myelopathy. METHODS: In this one-year, prospective, single-center observational study, serum 25-OH vitamin D levels were measured perioperatively in adult patients. Serum vitamin D levels <30 ng/mL were considered abnormal. The primary outcome measures were postoperative patient-reported outcomes (Neck Disability Index, Visual Analog Scale, EuroQol EQ-5D-3L, EQ-VAS). Secondary outcome measures were the presence of and time to solid bony fusion, controlling for Body Mass Index (BMI), age, and number of motion segments. RESULTS: Forty-one of 58 patients (71%) had laboratory-confirmed abnormal vitamin D levels. Patients with low vitamin D were younger (P<0.05) and had a higher BMI (P<0.05) than patients with adequate vitamin D, but the groups were otherwise similar. There were no differences in mean time to fusion between the two groups, but patients with low vitamin D reported more postoperative disability (P<0.05). Multivariate model analysis demonstrated an independent, significant association between normal vitamin D and lower postoperative neck disability index (P=0.05) and EQ-5D-3L (P=0.03). CONCLUSIONS: Vitamin D deficiency (<30 ng/mL) is highly prevalent in patients undergoing elective spinal fusion for cervical myelopathy. Low vitamin D levels were associated with worse patient-reported outcomes and were an independent predictor of greater disability, which suggests vitamin D supplementation may offer some benefit in these patients.

[Effects on cervical spondylosis of vertebral artery type and the concentrations of plasma NPY and UII in the patients treated with the modified acupuncture at unilateral/bilateral Renying (ST 9)].

OBJECTIVE: To observe the differences in the clinical therapeutic effects on cervical spondylosis of vertebral artery type (CSA) between the modified acupuncture and the routine acupuncture at unilateral/bilateral Renying (ST 9) as well as the impacts on the concentrations of plasma neuropeptide Y (NPY) and urotensinⅡ(UⅡ) in the patients. METHODS: A total of 160 patients were divided into a modified bilateral acupuncture group, a modified unilateral acupuncture group, a routine bilateral acupuncture group and a routine unilateral acupuncture group, 40 cases in each one according to the random number table. In the modified bilateral acupuncture group, the modified acupuncture was applied bilaterally to Renying (ST 9). In the modified unilateral acupuncture group, the modified acupuncture was applied unilaterally to Renying (ST 9). In the routine bilateral acupuncture group, the routine acupuncture was applied bilaterally to Renying (ST 9). In the routine unilateral acupuncture group, the routine acupuncture was applied unilaterally to Renying (ST 9). The treatment was given once every day, continuously for 6 days as one course. Two courses of treatment were required at the interval of 1 day. In each group, before and after treatment, we observed the peak systolic blood flow velocity (Vs) of the vertebral artery (VA) and the basilar artery (BA), cervical vertigo symptoms and functional assessment scales (ESCV) and the concentration of plasma NPY and UⅡ. The clinical therapeutic effects were compared among the groups. RESULTS: After treatment, the clinical therapeutic effect in the modified bilateral acupuncture group was 90.0% (36/40), which was better than 80.0% (32/40) in the modified unilateral acupuncture group, 77.5% (35/40) in the routine bilateral acupuncture group and 65.0% (26/40) in the routine unilateral acupuncture group (all P<0.05). After treatment, Vs of VA and BA was improved remarkably in every group (all P<0.01), and the result in the modified bilateral acupuncture group was higher than those in the other groups (all P<0.01). After treatment, ESCV scores were all increased remarkably in every group (all P<0.01). ESCV score and improvement index in the modified bilateral acupuncture group were all higher than those in the other groups (P<0.05, P<0.01). After treatment, the concentrations of plasma NPY and UⅡ were all reduced remarkably in every group (all P<0.01) and the differences were significant among the groups (all P<0.01). CONCLUSION: The modified bilateral acupuncture at Renying (ST 9) effectively regulates the blood supply of the vertebral basilar artery and improves the cerebral circulation. The effects are superior to those of the unilateral acupuncture at Renying (ST 9).

Serum pentosidine concentration is associated with radiographic severity of lumbar spondylosis in a general Japanese population.

The aim of this study was to investigate the relationship between the radiographic severity of lumbar spondylosis (LS) and serum bone metabolic markers. A total of 681 individuals volunteered for this study (269 men, 412 women; age: 54.9 ± 14.3; body mass index [BMI]: 23.1 ± 3.3 kg/m2). Lateral lumbar radiographs were evaluated in each intervertebral section (L1/2 to L5/S1) using the Kellgren-Lawrence grade (KL). If at least one intervertebral section was graded as KL 2 or greater, the participants were considered to have LS. The summation of each section of intervertebral section was used as the radiographic severity value of LS. In addition, bone status was evaluated with an osteo-sono assessment index (OSI) at the calcaneus. Serum bone alkaline phosphatase (µg/mL), N-telopeptide of type I collagen (nMBCE/L), and pentosidine (pmol/mL) concentrations were examined and used as the bone metabolism index. Stepwise multiple linear regression analysis was conducted with the radiographic severity value of LS as the dependent variable and age, sex, BMI, OSI, and the value of serum bone metabolic markers as the independent variables. The total number of LS participants was 470 (69.0 %); the frequency of LS was higher in men (n = 198) than in women (n = 272; P = 0.036, χ 2 test). The mean severity value of LS was 7.1 ± 4.4, and the mean value of pentosidine was 120.7 ± 54.8 pmol/mL. On multiple regression analysis, age (B = 0.190, ß = 0.611), sex (men = 1, women = 2; B = -0.900, ß = -0.099), BMI (B = 0.185, ß = 0.136), and pentosidine (B = 0.009, ß = 0.115) were significantly correlated with the severity of LS. Serum pentosidine concentration was positively correlated with the radiographic severity of LS in this cross-sectional study.

Serum levels of 25-hydroxyvitamin D and the occurrence of musculoskeletal diseases: a 3-year follow-up to the road study.

UNLABELLED: Assessment of serum 25-hydroxyvitamin D levels in association with the occurrence of musculoskeletal diseases using a population-based cohort study design revealed that serum 25-hydroxyvitamin D levels could predict the occurrence of osteoporosis at the femoral neck within 3 years, but not the occurrence of knee osteoarthritis or lumbar spondylosis. INTRODUCTION: The aim of this study is to clarify the association between serum 25-hydroxyvitamin D (25D) levels and occurrence of osteoporosis and osteoarthritis in the general population. METHODS: The Research on Osteoarthritis/Osteoporosis Against Disability study, a large-scale population-based cohort study, was performed during 2005-2007. Serum 25D levels were measured in 1,683 participants. Of these, 1,384 individuals (81.9%) completed a second follow-up survey 3 years later. Osteoporosis was defined according to World Health Organization criteria, in which osteoporosis is diagnosed by T-scores of bone mineral density (BMD) that are 2.5 standard deviations (SD) less than normal BMD. Knee osteoarthritis and lumbar spondylosis were defined as Kellgren-Lawrence grade ≥2, using paired X-ray films. Cumulative incidences were determined according to changes in measurements using World Health Organization criteria for osteoporosis or Kellgren-Lawrence grades for osteoarthritis between the baseline and second survey. RESULTS: The mean (SD) serum 25D level of the 1,384 participants in both surveys was 23.4 ng/mL (6.5). The annual cumulative incidences of osteoporosis at L2-4 and the femoral neck were 0.76 and 1.83%/year, respectively. The incidences of knee osteoarthritis and lumbar spondylosis were 3.3 and 11.4%/year, respectively. After adjusting for potential associated factors, logistic regression analyses revealed that the odds ratio for the occurrence of femoral neck osteoporosis significantly decreased as serum 25D levels increased (+1 SD; odds ratio 0.67; 95% confidence interval 0.49-0.92; p = 0.014). CONCLUSIONS: Higher serum 25D levels may prevent the occurrence of osteoporosis at the femoral neck, but not knee osteoarthritis, lumbar spondylosis, or osteoporosis at L2-4.

Postoperative changes of early-phase inflammatory indices after uncomplicated anterior cervical discectomy and fusion using allograft and demineralised bone matrix.

PURPOSES: We investigated sequential levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in uncomplicated ACDF (anterior cervical discectomy and fusion) using allograft and DBM (demineralised bone matrix) for primary cervical spondylosis and/or disc herniation. To our knowledge, there has been no study to investigate the diagnostic value of CRP and ESR for postoperative infection in ACDF using allograft and DBM. METHODS: Blood samples of 85 patients, who underwent one- (n = 51) or two-level (n = 34) ACDF, were obtained and evaluated before surgery and on the first, third, fifth, seventh, 14th, 30th, and 90th postoperative days. No infection was found in any patient for at least one year follow-up period. RESULTS: Mean CRP value increased significantly on the first postoperative day and reached a peak on the third postoperative day. The peak level rapidly decreased but remained elevated on the fifth, seventh, and 14th postoperative days. Mean ESR value increased significantly and reached a peak on the third postoperative day. The peak level gradually decreased but remained elevated on the fifth and seventh postoperative days. One- and two-level ACDF exhibited similar postoperative changes in CRP and ESR values and no significant difference in mean levels of CRP and ESR throughout the follow-up periods. CONCLUSIONS: This study demonstrates that uncomplicated ACDF using allograft and DBM showed significant abnormal values of CRP and ESR during the early postoperative period. This result suggests that abnormal values of CRP and ESR in the early postoperative period do not indicate acute postoperative infection after ACDF using allograft and DBM. Straying from the normal course, such as a second rise or a failure to decrease, of CRP and ESR is more important to signpost acute postoperative infection in ACDF using allograft and DBM.

Significance of serial S100b and NSE serum measurements in surgically treated patients with spondylotic cervical myelopathy.

BACKGROUND: Predicting functional outcome following surgery performed for spinal cord compression is still a considerable problem. Recent observations, though, strongly suggest that with serial measurements of serum S100b, this might be possible in patients with subacute spinal cord compression. The aim of this study was to examine whether this potential significance of S100b applies as well to patients with spondylotic cervical myelopathy. A further purpose was to assess the value of NSE in this regard, another biochemical marker widely used to monitor cerebral lesions. METHODS: Fifty-one patients were included in this prospective study. Outcome was considered as favourable in case of neurological improvement with preservation or retrieval of walking ability, whereas non-improvement without restoration of gait function was regarded as unfavourable. The preoperative levels of S100b and NSE were correlated with the degree of paresis, duration of symptoms, and presence of intramedullary high signal intensities on MRI. The postoperative values of both markers were correlated with outcome. FINDINGS: The preoperative levels of S100b were neither correlated with degree or duration of paresis nor with outcome. In case of an uncomplicated course the postoperative levels of S100b were also not correlated with outcome. In complicated courses with acute postoperative deterioration normal values on the 3rd day after the event were associated with a favourable outcome, whereas one patient with unfavourable outcome showed a persistent pathological increase. The serum levels of NSE were not correlated with clinical parameters or with outcome in any of the cases. CONCLUSIONS: Serial S100b serum measurements do not permit prediction of functional outcome in patients with spondylotic cervical myelopathy in case of an uncomplicated postoperative course. In complicated courses with postoperative deterioration, such measurements reflect postoperative events with possibly prognostic relevance. NSE does not have any significance in these patients with chronic lesions of the spinal cord.