A single centre service evaluation of degenerative cervical and thoracic myelopathy.

Background: Degenerative cervical myelopathy (DCM) and degenerative thoracic myelopathy (DTM) present with leg, bladder and bowel symptoms. If imaging confirms spinal cord compression both conditions are usually managed surgically. Surgical timing is important in patient management as it affects post-operative recovery and long-term outcomes.

Life expectancy in patients with degenerative cervical myelopathy is currently reduced but can be restored with timely treatment.

Purpose: Degenerative cervical myelopathy is a progressive slow-motion spinal cord injury. Surgery is the mainstay of treatment. Baseline disability predicts surgical recovery; therefore, timely treatment is critical to restoring function.

Comparison of health-related quality of life in patients with traumatic brain injury, subarachnoid haemorrhage and cervical spine disease.

Purpose: The degree of disability that is acceptable to patients following traumatic brain injury (TBI) continues to be debated. While the dichotomization of outcome on the Glasgow Outcome Score (GOSE) into 'favourable' and 'unfavourable' continues to guide clinical decisions, this may not reflect an individual's subjective experience. The aim of this study is to assess how patients' self-reported quality of life (QoL) relates to objective outcome assessments and how it compares to other debilitating neurosurgical pathologies, including subarachnoid haemorrhage (SAH) and cervical myelopathy.

Hard collar immobilisation following elective surgery on the cervical spine: a cross-sectional survey of UK spinal surgeons.

Introduction: Although mostly used in the management of spinal trauma, hard collar immobilisation is also used as an adjunct to recovery after elective cervical spine surgery. Many surgeons believe that bracing reduces the risk of non-union and pain and provides a subjective sense of security for patients. There is little if any, evidence for this practice and immobilisation can be a direct cause of adverse events.

Adverse Events Relating to Prolonged Hard Collar Immobilisation: A Systematic Review and Meta-Analysis.

Study Design: Systematic review and meta-analysis.

Objective: To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar.

Methods: Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted.

Lumbar decompression surgery for cauda equina syndrome - comparison of complication rates between daytime and overnight operating.

Purpose: To investigate the incidence of complications from lumbar decompression ± discectomy surgery for cauda equina syndrome (CES), assessing whether time of day is associated with a change in the incidence of complications.

Methods: Electronic clinical and operative notes for all lumbar decompression operations undertaken at our institution for CES over a 2-year time period were retrospectively reviewed. "Overnight" surgery was defined as any surgery occurring between 18:00 and 08:00 on any day.

Current surgical practice for multi-level degenerative cervical myelopathy: Findings from an international survey of spinal surgeons.

Unlabelled: Degenerative cervical myelopathy (DCM) results from compression of the cervical spine cord as a result of age related changes in the cervical spine, and affects up to 2% of adults, leading to progressive disability. Surgical decompression is the mainstay of treatment, but there remains significant variation in surgical approaches used. This survey was conducted in order to define current practice amongst spine surgeons worldwide, as a possible prelude to further studies comparing surgical approaches.

UK Chiari 1 Study: protocol for a prospective, observational, multicentre study.

Introduction: Chiari 1 malformation (CM1) is a structural abnormality of the hindbrain characterised by the descent of the cerebellar tonsils through the foramen magnum. The management of patients with CM1 remains contentious since there are currently no UK or international guidelines for clinicians. We therefore propose a collaborative, prospective, multicentre study on the investigation, management and outcome of CM1 in the UK: the (UKC1S).

Establishing mild, moderate and severe criteria for the myelopathy disability index in cervical spondylotic myelopathy.

Aim: Cervical Spondylotic Myelopathy (CSM) is a disabling condition arising from arthritic compression and consequent injury of the cervical spinal cord. Stratification of CSM severity has been useful to inform clinical practice and research analysis. In the UK the Myelopathy Disability Index (MDI) is a popular assessment tool and has been adopted by the British Spinal Registry.

Provision and Perception of Physiotherapy in the Nonoperative Management of Degenerative Cervical Myelopathy (DCM): A Cross-Sectional Questionnaire of People Living With DCM.

Study Design: Cross-sectional survey.

Objectives: Degenerative cervical myelopathy (DCM) is a common syndrome of acquired spinal cord impairment caused by canal stenosis secondary to arthritic changes of the spine. International guidelines consider physiotherapy an option for mild, stable DCM; however, few studies have been conducted on nonoperative management.

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

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.

A comparison of radiological descriptions of spinal cord compression with quantitative measures, and their role in non-specialist clinical management.

Introduction: Magnetic resonance imaging (MRI) is gold-standard for investigating Degenerative Cervical Myelopathy (DCM), a disabling disease triggered by compression of the spinal cord following degenerative changes of adjacent structures. Quantifiable compression correlates poorly with disease and language describing compression in radiological reports is un-standardised.

Study Design: Retrospective chart review.

The utility of diagnostic selective nerve root blocks in the management of patients with lumbar radiculopathy: a systematic review.

Objective: Lumbar radiculopathy (LR) often manifests as pain in the lower back radiating into one leg (sciatica). Unsuccessful back surgery is associated with significant healthcare costs and risks to patients. This review aims to examine the diagnostic accuracy of selective nerve root blocks (SNRBs) to identify patients most likely to benefit from lumbar decompression surgery.

Cord Splitting Access to Ventral Intradural Cysts of Cervicothoracic Junction and Thoracic Spine.

Objective: Surgical treatment of ventrally located intradural cysts is difficult and controversial. Laminectomy with division of the denticulate ligaments and gentle cord mobilization remains the standard approach but risks further neurologic deterioration secondary to cord manipulation. Our purpose is to evaluate the safety and effectiveness of a midline cord-splitting approach as an alternative for treating ventral thoracic intradural cysts.

Combined radiological and surgical management of spinal dural fistulas.

Introduction: Spinal Dural Fistulas (SDAVF) are the most common Spinal Vascular Malformation. The management of SDAVFs involves diagnosis and localisation with MRI and spinal angiography and subsequent embolisation or surgical interruption. We report our experience in treating these fistulas in which we undertake endovascular treatment, if technically feasible, with recourse to surgery only if occlusion is not possible.

A summary of assessment tools for patients suffering from cervical spondylotic myelopathy: a systematic review on validity, reliability and responsiveness.

Purpose: One of the objectives of this review is to summarize the important features of a good scale. A second aim is to conduct a systematic review to identify scales that can detect the presence of cervical myelopathy and to determine their psychometric properties including validity, reliability and responsiveness.

Methods: A thorough literature search was performed using MEDLINE, MEDLINE in process, EMBASE, and Cochrane Central Register of Controlled Trials.

Transient perioperative brainstem paralysis secondary to a local anesthetic.

Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure.

Psychological distress does not compromise outcome in spinal surgery.

Summary Of Background Data: Physical outcomes following surgery for degenerative spine disease have been well studied whereas the importance of psychological factors has only recently been acknowledged. Previous studies suggest that pre-operative psychological distress predicts poor outcome from spinal surgery. In the drive to identify patients who will not benefit, these patients risk being denied surgery.

Minimally invasive lumbar decompression: long-term outcome, morbidity, and the learning curve from the first 50 cases.

Study Design: Prospective observational study.

Objective: To describe our experience with the first 50 cases of minimally invasive lumbar canal decompression in terms of patient outcome up to 2 years, the learning curve incurred, and complications when compared with our most recent 50 cases.

Summary Of Background Data: Lumbar canal stenosis is a common condition in the elderly population, the symptoms of which respond well to surgical decompression.

A modified Roland-Morris disability scale for the assessment of sciatica.

Background: The Roland-Morris disability scale (RMS) for disability secondary to low back pain is a validated and popular instrument in clinical practice and research. We have made a simple modification to the questionnaire to increase sensitivity to sciatica (RMS-L) and validated this in patients with lumbar disc prolapse and radiculopathy.

Methods: The original RMS and modified RMS-L were prospectively administered to 203 patients presenting with lumbar radiculopathy and intervertebral disc prolapse demonstrated on MRI.

The Short Form 36 health survey in spine disease--validation against condition-specific measures.

Health-Related Quality of Life (HRQoL) assessments in spinal disease offer the potential of outcome measures that better represent patients' disability and response to treatment. The Short Form 36 Health Survey (SF-36) is a generic HRQoL questionnaire that has been extensively used in primary and secondary care, but before it can be routinely applied in patients with spinal disease must be validated against traditional specific measures of physical and mental morbidity. Patients with lumbar disc prolapse, lumbar canal stenosis, and cervical spondylotic radiculomyelopathy were identified from a prospectively maintained database.