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Background: Cervical spondylotic myelopathy (CSM) results in sensorimotor limb deficits, bladder, and bowel dysfunction, but mechanisms underlying motor plasticity changes before and after surgery are unclear.
Methods: We studied 24 patients who underwent decompression surgery and 15 healthy controls. Patients with mixed upper and lower limb dysfunction (Group A) and only lower limb dysfunction (Group B) were then analysed separately.
Results: The sum amplitude of motor evoked potentials sMEP (p < 0.01) and number of focal points where MEPs were elicited (N) (p < 0.001) were significantly larger in CSM patients compared with controls. For Group A (16 patients), sMEP (p < 0.01) and N (p < 0.001) showed similar findings. However, for Group B (8 patients), only N (p = 0.03) was significantly larger in patients than controls. Group A had significantly increased grip strength (p = 0.02) and reduced sMEP (p = 0.001) and N (p = 0.003) after surgery. Changes in sMEP (cMEP) significantly correlated inversely with improved feeding (p = 0.03) and stacking (p = 0.04) times as was the change in number of focal points (NDiff) with improved writing times (p = 0.03). Group B did not show significant reduction in sMEP or N after surgery, or significant correlation of cMEP or NDiff with all hand function tests. No significant differences in H reflex parameters obtained from the flexor carpi radialis, or central motor conduction time changes, were noted after surgery.
Discussion: Compensatory expansion of motor cortical representation occurs largely at cortical rather than spinal levels, with a tendency to normalization after surgery. These mirrored improvements in relevant tasks requiring utilization of intrinsic hand muscles.
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http://dx.doi.org/10.1155/2015/389531 | DOI Listing |
Interv Pain Med
December 2024
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14623, USA.
Background: Cervical interlaminar epidural steroid injections (CIESI) are frequently used to treat cervical radiculopathy due to cervical nerve root impingement.
Objective: The purpose of this study was to evaluate the therapeutic effect of CIESI for patients with cervical radiculopathy.
Methods: We conducted a retrospective review of consecutive adult patients with cervical radicular pain and corroborative cervical spondylotic foraminal stenosis on MRI that failed at least 6 weeks of conservative management consisting of medication and physical rehabilitation seen at a multidisciplinary, tertiary academic spine center.
Zhongguo Gu Shang
December 2024
Department of Spine Surgery, Ningbo No.6 Hospital, Ningbo 315040, Zhejiang, China.
Objective: To explore clinical effect of Zero-profile intervertebral fusion with cage-titanium plate in treating multilevel cervical spondylotic myelopathy.
Methods: From January 2016 to January 2020, 107 patients with multisegmental cervical spondylotic myelopathy treated by surgery were retrospectively analyzed and divided into Hybrid group and control group according to different surgical methods. There were 54 patients in Hybrid group, including 42 males and 12 females, aged from 33 to 77 years old with an average of (57.
World Neurosurg
December 2024
Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, 200040, China; Spine Center Fudan University, Shanghai, 200040, China. Electronic address:
Background: To measure the muscle strength around the cervical spine; clarify the relationships among muscles, cervical sagittal alignment, and cervical spondylotic myelopathy(CSM); and understand the process underlying loss of cervical lordosis.
Methods: Sex, age, course of illness, and radiological data were obtained for patients with CSM and a control group of healthy individuals. C2-7 Cobb angles were measured in cervical radiographs, and the vertebral body areas(VBAs) and cross-sectional areas(CSAs) of the deep flexors, superficial flexors(SF), deep extensors, and superficial extensors(SE) were measured from the C3/4 to C6/7 intervertebral levels in T2-weighted axial magnetic resonance images.
J Clin Med
November 2024
Department of Orthopedics, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA.
: Degenerative cervical myelopathy is a progressive neurological disorder that is commonly encountered in clinical practice and its incidence is expected to increase alongside the aging population. Given the importance of early and accurate diagnosis in this patient population, this narrative review aims to provide a repository of up-to-date information regarding pertinent patient history, physical exam findings, and potential alternate diagnoses. : The PubMed database was queried for publications from 1 January 2019 to 19 March 2024.
View Article and Find Full Text PDFCureus
November 2024
Neuroanesthesia, Unidade Local de Saúde de Santo António, Porto, PRT.
Cervical spine surgery in patients with myelopathy poses a substantial anesthetic challenge, primarily due to the risk of secondary spinal cord injury (SCI). Traditionally, concerns have centered around cervical movements during intubation. However, limited evidence supports a direct link between intubation and SCI, so anesthesiologists must consider other factors, including patient positioning, spinal perfusion pressure, and direct surgical complications.
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