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Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to...

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Autores principales: Severino, Rocco, Nouri, Aria, Tessitore, Enrico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141260/
https://www.ncbi.nlm.nih.gov/pubmed/32168833
http://dx.doi.org/10.3390/jcm9030759
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author Severino, Rocco
Nouri, Aria
Tessitore, Enrico
author_facet Severino, Rocco
Nouri, Aria
Tessitore, Enrico
author_sort Severino, Rocco
collection PubMed
description Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.
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spelling pubmed-71412602020-04-10 Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery? Severino, Rocco Nouri, Aria Tessitore, Enrico J Clin Med Article Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM. MDPI 2020-03-11 /pmc/articles/PMC7141260/ /pubmed/32168833 http://dx.doi.org/10.3390/jcm9030759 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Severino, Rocco
Nouri, Aria
Tessitore, Enrico
Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title_full Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title_fullStr Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title_full_unstemmed Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title_short Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?
title_sort degenerative cervical myelopathy: how to identify the best responders to surgery?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141260/
https://www.ncbi.nlm.nih.gov/pubmed/32168833
http://dx.doi.org/10.3390/jcm9030759
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