Atypical cervical spondylotic radiculopathy resulting in a hypertensive emergency during cervical extension: A case report and review of literature

BACKGROUND Extensive research revealed the absence of reports documenting hypertensive emergencies precipitated by changes in the cervical spine posture.CASE SUMMARY We here present a 57-year-old woman diagnosed as having cervical spondylotic radiculopathy(CSR)who was scheduled for anterior cervical decompression and fusion.During post-anesthetic positioning,a sudden hypertensive surge was observed when the patient was in a supine position with the neck being slightly extended.This surge was promptly reversed through cervical flexion and head elevation.This event however required an alternate surgical approach for recovery—posterior laminoplasty and endoscopy-assisted nucleus pulposus removal.Following the 6-month outpatient follow-up period,cervical flexion and extension activities substantially improved in the patient without any episodes of increase in acute blood pressure.CONCLUSION Maintaining a safe hypotensive posture and performing rapid,thorough deco-mpression surgery may serve as effective interventions for patients presenting symptoms similar to those of CSR accompanied by hypertensive emergencies(HE).This would mitigate the underlying causes of these HEs.

Multilevel cervical spondylotic myelopathy treated by anterior cervical decompression in subsection and autograft fusion

Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.

Cervical spondylotic myelopathy with syringomyelia presenting as hip Charcot neuroarthropathy:A case report and review of literature

BACKGROUND Charcot neuroarthropathy(CN)is a systemic disease characterized by progressive bone loss and destruction,which is usually closely related to diabetes,HIV,etc.However,CN caused by syringomyelia accounts for only 5%of CN cases;the shoulder and elbow are most often involved,and the hip joint is rarely affected.As a rare factor,cervical spondylotic myelopathy(CSM)can be associated with syringomyelia,which is scarcely reported in the literature.Here,we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.CASE SUMMARY We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago.Four years ago,he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis.Recently,however,his symptoms gradually worsened,and because of progressive pain,destabilization and weakness of the right hip,he was admitted to our hospital.Through systematic physical,radiographic and laboratory examinations,we finally reached a diagnosis:CN of the right hip associated with syringomyelia secondary to CSM.After comprehensive evaluation of the patient's condition,we performed right total hip arthroplasty.During the follow-up,the patient felt well clinically and could walk independently with a knee brace.CONCLUSION We suggest a possible etiological association between CSM and syringomyelia,which may reflect a potential pathogenesis of CN.We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions,especially chronic shoulder neck pain,to rule out the possibility of this association,which plays a crucial role in the early diagnosis of CN.Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN.Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.

Application of anterior decompression and reconstruction using titanium mesh with locking plates in the management of cervical spondylotic myelopathy

Objective：To observe the clinical effect of anterior decompression and reconstruction using titanium mesh with locking plates in the treatment of cervical spondylotic myelopathy. Methods：One hundred and twenty patients with cervical spondylotic myelopathy were treated by anterior decompression and reconstruction using titanium mesh with locking plates. There were 66 men and 54 women ranges in age from 37 to 72 Years（mean age, 58.3 years）. The mean Japanese orthopedic surgery association（JOA） scale was 9.6 points before operation. Patients were followed up clinically and radiographically. Results：Having stood surgery well, the operation time ranged between 60-100 min and bleeding during operation ranged between 20-200 ml. There were no case of postoperative infection, recurrent laryngeal nerve palsy, or esophageal or tracheal laceration or rupture. The average follow-up period was 14.3 months（range, 12 to 24 months） in 96 who were followed up. At the last follow-up visit the mean JOA scale had improved to 14.4 points, reflecting an improvement of 4.8 points. The results were considered to be excellent in 87 patients, good in 25, fair in 6, and poor in 2. No hardware-related complications or adjacent segment degenerative changes were encountered during the follow-up periods. Stable bone union was observed in all cases and the average time required for fusion was 5.7 months. Conclusion：Titanium mesh filled with autologous bone graft can avoid the complications associated with harvesting bone from the iliac crest donor site. When combined with cervical anterior locking plate, it can obtain satisfatory clinical results for the treatment of cervical spondylotic myelopathy.

Functional evaluation using several evoked spinal cord potentials in elderly patients with cervical spondylotic myelopathy

BACKGROUND ： The recordings of evoked spinal cord potentials following epidural spinal cord stimulation are thought to be generated by volleys traversing the dorsal column pathway, and it may not directly reflect conduction defects in corticospinat tracts of cervical spinal cord. To our knowledge there has been few report using several evoked spinal cord potentials in function evaluation of the cervical spinal cord in eldedy patients with cervical spondylotic myelopathy （CSM）. OBJECTIVE： To investigate the function states of the cervical spinal cord in elderly patients with CSM and explore its pathophysictogic mechanism. DESIGN： Case observation SETTING ： Department of Orthopedics for the aged, Shenzhen Pingle Hospital of Orthopedics. Department of Orthopedic Surgery, Yamaguchi University School of Medicine. PARTICIPANTS ： A total of 23 eldedy patients with CSM who received treatment in the Department of Orthopedic Surgery, Yamaguchi University School of Medicine of Japan from January 2003 to February 2004 were enrolled in this study. Inclusive criteria： ① Multiple intervertebral levels of cervical spinal cord compression confirmed by MRI, e.g. 3 or more than 3 levels of compressin. ② Age ≥ 70 years old. ③ Numbness and sensory disturbance in the upper limbs and showed hyperreflexia in the lower limbs. Exclusive criteria： Patients with abnormal motor and sensory nerve conduction velocities in both upper and lower limbs were excluded. METHODS： Evoked spinal cord potentials （ESCPs） following transcranial electric stimulation （TCE-ESCPs）, epidural spinal cord stimulation （SpinaI-ESCPs） and median nerve stimulation （MN-ESCPs） were recorded in 23 patients from posterior epidural space intreoperatively. The abnormalities of TCE-ESCPs were defined as attenuation of amplitude of the D wave. The most cranial intervertebral level showing abnormal TCE-ESCPs with a marked reduction in size of the negative peak （reduction of over 50%） was considered as the upper level of the spinal cord lesion with respect to the corticospinal tract in white matter. The abnormalities of SpinaI-ESCPs were defined as marked reduction in the size of negative peak （reduction of over 50%）. The most caudal intervertebral level showing abnormal SpinaI-ESCPs was considered as the lower level of the spinal cord lesion with respect to the dorsal column pathway in white matter. The abnormalities of MN-ESCPs were defined as attenuation of the N13 amplitude,which was considered as the lesion level of the spinal cord with respect to the dorsal horn in gray matter. Radiological investigation： Lateral view of plain X-ray films was obtained in flexion and extension of the cervical spine. Instability of the cervical intervertebral level was determined as horizontal displacement of the vertebral body of over 3 mm. MAIN OUTCOME MEASURES ： The results of examination of TCE-ESCPs, SpinaI-ESCPs and MN-ESCPs in el- dedy patients with CSM. RESULTS： The 23 eldedy patients with CSM were participated in the result analysis. ①TCE-ESCPs： The impairment of the corticospinal tract in white matter at single intervertebral level was revealed in 18 of 23 patients by recordings of TCE-ESCPs （sensitivity 78%）. In the 18 patients, the lesion level was shown at the up- per cervical segment in 14 patients （C3-4n=10 and C4-5n=4）, and at the lower cervical segment in 4 patients （C5-6n=4）. ②Spinal-ESCPs： The impairment of the dorsal column pathway of white matter at single intervertebral level was revealed in 17 of 23 patients, by recordings of Spinal-ESCPs （sensitivity 74%）. In the 17 patients, the lesion level was presented at the upper cervical segment in 14 patients （C3-4n=10 and C4-5n=4）, and at the lower cervical segment in 3 patients （C5-6 n=3）. ③MN-ESCPs： All patients revealed abnormal MN-ESCPs at one or more intervertebral levels （sensitivity 100%）. The impairment at single intervertebral level was demonstrated in 17 patients, and the impairment at multiple intervertebral levels was shown in 4 patients （3 patients at the C3-4, C4-4, and C5-4~6, and one patient at the C4-5, C5-6, and C6-7）. ④Radiological findings： The Instability of the intervertebral level at the C3-4 or C4-5 motion segment was seen in 15 patients, with a total of 20 levels, and where 10 were at the C3-4 intervertebral level and 5 were at the C3-4, C4-5 intervertebral level. CONCLUSION ： The results suggest that in most elderly patients with CSM who have multiple intervertebral level compressions of the cervical spinal cord on MRI, white matter is impaired at the single cervical intervertebral level, and not only the dorsal column pathway, but also the corticospinal tract can be affected. Combined the findings of radiography, the excessive motion and instability of the C3-4 or C4-5 intervertebral level plays an important role in inducing the long tract lesion in elderly patients with CSM.

A wake up call for cervical spondylotic myelopathy in young age : a case report

A 30 yrs male,was admitted with complains ofneck pain,weakness in both upper and lower limbs forfour months and mild intermittent paresthesia along hisupper limbs.Physical examination showed mild senso-ry deficit

Spontaneous Cervical Epidural Hematomas in Mild Cervical Spondylotic Myelopathy Patients：An Analysis of 8 Cases

Spontaneous cervical epidural hematoms（SCEH） complicated with mild cervical spondylotic myelopathy（CSM） is a rare but emerging condition.Early diagnosis and treatment are important for good outcomes.This study aimed to investigate the clinical characteristics of this condition and to discuss the optimal treatment.The clinical data from 8 patients with SCEH plus CSM who were divided into two groups by treatment methods were retrospectively analyzed.The neurological function of the patients was assessed by Japanese Orthopedic Association（JOA） score before and after the surgical operations.Other factors were reviewed with medical records.Among them,4 out of the 8 patients underwent emergency surgery,and the rest 3 patients experienced an initial conservative treatment and ultimately received a laminectomy.We found that the Frankel Scale scores in most of the surgical patients were increased after surgery（6/7,85.7%）.However,the JOA scores at the 6th month after onset were even lower than those before onset in 3 of the operative cases,and those in the patients who were given conservative treatment showed no significant change.It was concluded that some patients with SCEH and CSM treated with a timely operation may obtain relief from their previous CSM symptoms.However,the final neurological deficits of these patients were closely related to the progressive interval which refers to the hours between the initial onset and the occurrence of new neurological deficits or mild CSM deterioration,no matter whether they accept the operation.We found the crucial progressive interval may be in 9 h.Early MRI and prompt neurosurgical intervention are also important to improve the neurological deficits.

Clinical Study of Acupotomy Trinity Lysis on Cervical Spondylotic Myelopathy with Liver and Kidney Deficiency Syndrome

Objective:To compare the therapeutic effects of acupotomy trinity lysis and traditional acupotomy on cervical spondylotic myelopathy.Methods:A total of 205 patients with cervical spondylotic myelopathy of liver and kidney deficiency syndrome were randomly divided into the experimental group(105 cases)and the control group(100 cases).The experimental group was relaxed with acupotomy in three positions:Heaven(tian),Human(ren)and Earth(di).Traditional acupotomy was used to relax Ashi acupoints of the affected vertebra in the control group.One treatment was conducted in one week,and the duration of one course of treatment was three weeks.The VAS,JOA score and NDI index were observed after treatment.Results:Before and after treatment,the total treatment efficiency of the treatment group was 95.23%,and that of the control group was 80.00%,there was significant difference between the two groups,P<0.05;Before operation,there was no significant difference in JOA score,NDI index score,and VAS score between the treatment group and the control group(P>0.05);there was no significant difference after 1 week(P>0.05),but there were significant differences between the two groups 2 weeks and 3 weeks after operation(P<0.05).Conclusion:Acupotomy trinity lysis is a safe,effective and economical treatment for cervical spondylotic myelopathy.

Selection of surgical methods for thoracic ossification of ligamentum flavum combined with cervical spondylotic myelopathy

Objective To investigate the difference between different surgical methods for thoracic ossification of ligamentum flavum(OLF) combined with cervical spondylotic myelopathy(CSM) . Methods From January 1991 to January 2003,56 cases

CLINICAL STUDY OF MOTOR EVOKED POTENTIALS BY MAGNETIC STIMULATION IN CERVICAL SPONDYLOTIC MYELOPATHY

The combined use of motor .yoked pot'ntlais (MEPs) with F way, recording was cornpared with somatesemory evoked potentials (SEPs) in order to evaluate the clinical value or MEPs incervical spondylotic myelopathy. Magnetic stimulation of motor cortex with F wave recording was used assess central motor conduction. time, (CMCT). and central somatoseusory conduction time(CSCT)was evaluated by SEPs in 20 pailents surffring from myeloP8thy of cervical spondylosis. Theresults were comapared with 20 control subjects. The results showed that CMCT of Patients was obviously prolonged then that of contral subjects, the sbnormal rate was 80% which was higher than70K of SEPs slid that the prolongation or CMCT had a good correlation with the severe degree ofmyelopathy. The Painless and noninvasive .magnetic stimulation of PEPs could figure out the compressed degree of motor descending pathway and was. useful technique for diagnosis of cervicalspondylotic myelopathy.

Machine learning-based detection of cervical spondylotic myelopathy using multiple gait parameters

Cervical spondylotic myelopathy(CSM)is the main cause of adult spinal cord dysfunction,mostly appearing in middle-aged and elderly patients.Currently,the diagnosis of this condition depends mainly on the available imaging tools such as X-ray,computed tomography and magnetic resonance imaging(MRI),of which MRI is the gold standard for clinical diagnosis.However,MRI data cannot clearly demonstrate the dynamic characteristics of CSM,and the overall process is far from costefficient.Therefore,this study proposes a new method using multiple gait parameters and shallow classifiers to dynamically detect the occurrence of CSM.In the present study,45 patients with CSM and 45 age-matched asymptomatic healthy controls(HCs)were recruited,and a three-dimensional(3D)motion capture system was utilized to capture the locomotion data.Furthermore,63 spatiotemporal,kinematic,and nonlinear parameters were extracted,including lower limb joint angles in the sagittal,coronal,and transverse planes.Then,the Shapley Additive exPlanations(SHAP)value was utilized for feature selection and reduction of the dimensionality of features,and five traditional shallow classifiers,including support vector machine(SVM),logistic regression(LR),k-nearest neighbor(KNN),decision tree(DT),and random forest(RF),were used to classify gait patterns between CSM patients and HCs.On the basis of the 10-fold cross-validation method,the highest average accuracy was achieved by SVM(95.56%).Our results demonstrated that the proposed method could effectively detect CSM and thus serve as an automated auxiliary tool for the clinical diagnosis of CSM.

Clinical practice guidelines of acupuncture-moxibustion for cervical spondylotic radiculopathy

On the basis of relevant literature and evidence, Clinical Practice Guidelines of Acupuncture-moxibust^on .for Cervical 5pondyloffc Radiculopathy has been formulated according to the quality of evidences and by adopting the method of Grades of Recommendations Assessment, Development and Evaluation （GRADE）, in which the objective of guidelines formulation, the scope of application of the guidelines, the principle of acupuncture-moxibustion treatment of cervical spondylotic radiculopathy, the time for intervention and different acupuncture-moxibustion regimens, etc. were specified.

Treatment of 30 patients with cervical spondylotic radiculopathy by acupuncture plus warming-needle moxibustion:a randomized controlled trial

Objective To observe the clinical efficacy of acupuncture plus warming-needle moxibustion for the treatment of cervical spondylotic radiculopathy.Methods Sixty patients with cervical spondylotic radiculopathy were randomly divided into a warming-needle moxibustion group（group A）and an acupuncture group（group B）according to random number table,with thirty cases in each group.For the patients in the group A,Fengchi（风池 GB 20）,Jingjiaji（Jiaji points on the neck）,Dazhui（大椎 GV 14）,Dazhu（大杼 BL 11）,Jugu（巨骨 LI 16）,Tianzong（天宗 SI 11）,Tianliao（天髎 TE 15）,Jianjing（肩井 GB 21） and Hegu（合谷 LI 4） were selected for warming-needle moxibustion.In the group B,Jianliao（肩髎 TE 14）,Jianyu（肩髃 LI 15）,Quchi（曲池 LI 11）,Tianjing（天井 TE 10）,Yangchi（阳池 TE 4）,and Waiguan（外关 TE 5） were selected for acupuncture.Both groups were treated once a day and ten times constituted a course of treatment.Results Compared with the group B,significant differences were observed in the group A after a course of treatment in terms of 20-score scoring for symptoms of cervical spondylotic radiculopathy,VAS scoring and clinical efficacy[16.63±2.31 vs 15.67±2.48,2.36±1.59 vs 3.98±2.32,100%（30/30） vs 86.7%,all P〈0.05].Conclusion Acupuncture plus warming-needle moxibustion can significantly reduce neck pain and improve neck function of patients with cervical spondylotic radiculopathy,which is worthy of clinical application due to its simple manipulation.

Treatment of cervical spondylotic radiculopathy: acupuncture at neck Jiájǐ points and blood-letting puncture with the plum-blossom needle

Objective To observe the therapeutic effect of acupuncture at neck Jiájǐ （EX） points and blood-letting puncture with the plum-blossom needle on cervical spondylotic radiculopathy. Methods Sixty cases of cervical spondylotic radiculopathy were divided into a treatment group and a control group with 30 cases in each group. Acupuncture at neck Jiájǐ （EX） points （Extra） and blood-letting puncture with the plum-blossom needle were adopted for the treatment group. And acupuncture at neck Jiájǐ （EX） points was adopted for the control group. The therapeutic effect, visual analogue scale （VAS） and the numbness score were observed after 2 treatment courses. Results The total effective rate of the treatment group was 86.7% （26/30）, while the rate of the control group was 83.3% （25/30）. Comparison of the differences of the two groups was without statistic significance （P0.05）. The VAS scores of the two groups after treatment were both improved （both P0.01）, but without statistic significance between the two groups （P0.05）. The numbness scores of the two groups after treatment were both better than those before treatment （P0.01）. The therapeutic effect on numbness of the extremities of the treatment group was better than that of the control group （P0.05）. Conclusion Blood-letting puncture with the plum flower needle has a satisfactory effect on treatment of numbness of the extremities of patient with cervical spondylotic radiculopathy.

Comparison of the anterior and posterior approach in treating four-level cervical spondylotic myelopathy

Background:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial.The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study.Perioperative information,intraoperative blood loss,clinical and radiological outcomes,and complications were recorded.Japanese Orthopedic Association(JOA)score,36-item short form survey(SF-36)score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively(11.6±1.6 vs.12.1±1.5),immediately postoperatively(14.4±1.1 vs.13.8±1.3),or at the last follow-up(14.6±1.0 vs.14.2±1.1)(P>0.05).The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values.The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up.The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value(69.4 vs.61.7).Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively(-2.0°±7.3°vs.-1.4°±7.5°).The Cobb angle significantly improved immediately postoperatively(12.3°±4.2°vs.9.2°±3.6°)and at the last follow-up(12.4°±3.5°vs.9.0°±2.6°)in both groups compared with their preoperative values(P=0.00).Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features.However,the JOA score recovery rate and SF-36 score in the anterior group were significantly higher.Persistent axial pain could be a major concern when undertaking the posterior approach.

System evaluation and Meta analysis on clinical effi cacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy

Objective To systematically evaluate the efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy（CSR）. Methods Chinese National Knowledge Infrastructure（CNKI）, China Biology Medical（CBM） database, Chinese Science and Technology Periodical Database（VIP）, Wan Fang Data, Pubmed and Cochrane Library were retrieved to search the randomized controlled trials（RCT） on heat-sensitive moxibustion in treatment of CSR, and Meta analysis was conducted by applying Rev Man 5.3 software. Results Eventually, 10 papers were included in this study, including 1008 subjects. Meta analysis result showed： the total effective rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.13, 95%CI（1.06, 1.21）, Z=3.54, P=0.000 4]; the cure rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.80, 95%CI（1.52, 2.13）, Z=6.82, P〈0.000 01]; the improvement of short-form Mc Gill pain questionnaire（SF-MPQ） of treatment group was superior to that of control group, and the difference was statistically significant [MD=–4.44, 95%CI（–6.38,-2.50）, Z=4.49, P〈0.000 01]; visual analogue scale（VAS） of treatment group was lower than that of control group, and the difference was statistically significant [MD=-0.36, 95%CI（-0.50, –0.23）, Z=5.42, P〈0.00001]; and the improvement of interleukin-6（IL-6） of treatment group was superior to that of control group, and the difference was statistically significant [MD=–7.32, 95%CI（-11.49, –3.14）, Z=3.44, P=0.000 6]. Conclusion It is indicated from the Meta analysis result that the clinical efficacy of heat-sensitive moxibustion or acupuncture combined with heat-sensitive moxibustion in treatment of CSR is superior to that of simple acupuncture or traditional suspended moxibustion, providing a new therapeutic method for treatment of CSR. However, the abovementioned conclusion still needs to be confirmed through randomized blind controlled trials with high quality and large sample size since the sample size of included studies was small, and the quality was low.

Value of somatosensory evoked potentials in diagnosis, surgical monitoring and prognosis of cervical spondylotic myelopathy

Background The value of somatosensory evoked potentials （SEPs） in the diagnosis and prognosis of cervical spondylotic myelopathy, as well as the usefulness of monitoring intraoperative potentials in terms of safety and predictive factors were investigated. Methods Each of the 76 myelopathic patients underwent surgical intervention. According to the wave configurations of the SEPs, the cases were categorised into four groups： Type Ⅰ, Ⅱ, Ⅲ and Ⅳ. The clinical myelopathy disability was classified and the severity of neurological deficits was scored. Clinical function after surgery was evaluated. Preoperative potentials and intraoperative monitoring were categorized. The correlations between .evoked potentials detection, monitoring, myelopathy disability and surgical outcome in the different groups were discussed. Results According to the configurations of the SEPs, there were 27 patients （36%） of Type Ⅰ, 30 patients （39%） of Type Ⅱ, 8 patients （11%） of Type Ⅲ, and 11 patients （14%） of Type Ⅳ. The categorised evoked potentials were shown to be significantly associated with the clinical representation of myelopathy （P 〈0.01） and the recovery rate from identifiable SEPs waves （groups A, B and C） was significantly higher than unidentifiable waves （group D, P〈0.01）. A deterioration of SEPs was detected in 23 cases （30%）, whereas there was no change in 40 cases （53%） and improvements in 13 cases （17%）. A significant difference in recovery rates could be observed in various monitoring groups within the short-term follow-up period, while there were no obvious differences in the long-term follow-up groups. Conclusions SEP technique is a valuable and practical tool for the diagnosis, monitoring and prognosis of myelopathy. Classified evoked potentials are well correlated with cervical spondylotic myelopathy disability, and unidentifiable SEPs waves in patients are indicative of a relatively poor outcome. In addition, intraoperative monitoring of SEPs plays an important role in protecting neural structures during cervical spine surgery.

Position of increased signal intensity in the spinal cord on MR images： does it predict the outcome of cervical spondylotic myelopathy？

Background Increased signal intensity （ISI） in the spinal cord on T2-weighted MR images has been reported in some previous researches, however no study focused on the position of the ISI in the spinal cord and its potential value. The aim of this study was to investigate the correlation between ISI position and the outcome of surgical treatment for cervical spondylotic myelopathy （CSM） patients. Methods A retrospective study was conducted. Pre- and post-operative clinical status was evaluated by modified Japanese Orthopaedic Association （JOA） score. ISI was evaluated according to the T2-weighted sequences. The JOA score and the recovery ratios among patients with ISI in gray matter （group A）, in both gray and white matter （group B）, and ISI-negative group were compared. Results Totally 64 patients were enrolled in this retrospective study. Preoperative JOA score of ISI positive and negative group had significant difference, but the recovery ratios had no significant difference （the recovery ratios of the two groups in week 1, week 26, and week 104 were （21.54±14.65）%, （50.56±14.76）%, （59.23±13.08）% and （20.25±14.32）%, （54.46±3.16）% and （61.26±29.4）%, respectively; P 〉0.05）. The recovery ratios of negative group and group A in week 104 were superior to group B （the recovery ratios of negative group, group A, and group B in week 104 were （61.26±29.49）%, （65.35±11.36）%, and （50.33±10.20）%, respectively; P 〈0.05）. Conclusions Patients with ISI in the gray matter alone on T2-weighted MR images did not have significantly different surgical outcomes compared with those without ISI. Patients with ISI in both gray and white matter had surgical outcomes that were worse than those without ISI.

Comparison of Functional and Radiological Outcomes Between Two Posterior Approaches in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.

Hybrid decompression technique and two-level corpectomy are effective treatments for three-level cervical spondylotic myelopathy

The optimal surgical strategy for multilevel cervical spondylotic myelopathy （CSM） has not been defined, and few comparative researches between hybrid decompression and multilevel corpectorny have been conducted. Here, we reported 28 patients of three-level CSM, of whom 12 underwent hybrid decompression and 16 two-level corpectomy, with each type of procedure chosen according to radiologic characteristics of those patients. Clinical and radiologic parameters of both groups showed various degrees of improvement. However, no statistically significant differences in Japanese Orthopedic Association （JOA） score improvement rate, graft fusion rate, post-operative neck disability index （NDI） or segmental lordosis between the two groups were found. We conclude that both hybrid decompression and two-level corpectomy could obtain satisfying clinical efficacy in the management of three-level CSM for appropriate patients.