Peripheral blood RNA biomarkers can predict lesion severity in degenerative cervical myelopathy

Degenerative cervical myelopathy is a common cause of spinal cord injury,with longer symptom duration and higher myelopathy severity indicating a worse prognosis.While numerous studies have investigated serological biomarkers for acute spinal cord injury,few studies have explored such biomarkers for diagnosing degenerative cervical myelopathy.This study involved 30 patients with degenerative cervical myelopathy(51.3±7.3 years old,12 women and 18 men),seven healthy controls(25.7±1.7 years old,one woman and six men),and nine patients with cervical spondylotic radiculopathy(51.9±8.6 years old,three women and six men).Analysis of blood samples from the three groups showed clear differences in transcriptomic characteristics.Enrichment analysis identified 128 differentially expressed genes that were enriched in patients with neurological disabilities.Using least absolute shrinkage and selection operator analysis,we constructed a five-gene model(TBCD,TPM2,PNKD,EIF4G2,and AP5Z1)to diagnose degenerative cervical myelopathy with an accuracy of 93.5%.One-gene models(TCAP and SDHA)identified mild and severe degenerative cervical myelopathy with accuracies of 83.3%and 76.7%,respectively.Signatures of two immune cell types(memory B cells and memory-activated CD4^(+)T cells)predicted levels of lesions in degenerative cervical myelopathy with 80%accuracy.Our results suggest that peripheral blood RNA biomarkers could be used to predict lesion severity in degenerative cervical myelopathy.

Cervical Myelopathy: Diagnostic Aspects, Surgical Treatment and Evolution of Patients Operated upon in Yaounde

Introduction: Although cervical myelopathy is the most common degenerative cervical spine pathology in adults, the indications and approaches of surgical treatment have not yet been clearly defined in the literature. Very few studies exist regarding these aspects in our setting, and they are mostly outdated. This study aimed to describe the diagnostic aspects, current surgical treatment with technical improvements, and progression in patients. Patients and Methods: We conducted a multicentre retrospective descriptive study over a 10-year period between January 2011 and January 2020 in three referral centres in Yaoundé. All patients who underwent surgery for cervical myelopathy were included. Results: Fifty-two patients were recruited. The rate of operated cervical myelopathies among all degenerative spinal pathologies was 14.05%. The M/F sex ratio was 3/1, and the average age was 52 ± 10 years. All included patients had gait problems, 90.38% demonstrated motor deficiency, and 67.30% experienced at least three levels of compression. Surgery was decided based on the Nurick grade;a posterior approach was applied to 86.54% of patients. Postoperative progression showed a neurological improvement of 82% with an average follow-up of 4 years. Conclusion: In this study, the patients who underwent surgery were relatively young, their clinical presentations were mostly advanced, and surgical management showed good results in well-selected cases.

Myelopathy as a Presentation of Cervical Spine Metastasis: A Case Report

Cervical myelopathy is a consequence of spinal cord compression in the cervical spine. Degenerative cervical spondylosis, osteophytes, discosteophyte complex, degenerative spondylolisthesis and hypertrophy of ligamentum flavum are the main etiologies of cervical myelopathy. Metastasis to cervical spine could be a rare cause of cervical myelopathy. The present study is a case report;presented a 36-year-old male with severe pain in cervical region, gait disability and impairment in sensory and motor function of upper left extremity. The patient had a history of thyroidectomy and cervical lymph node dissection due to follicular thyroid carcinoma (FTC) with improper follow-ups. He was diagnosed with metastatic cervical myelopathy and underwent surgical treatment. Cervical myelopathy due to metastasis is a rare condition and only few cases have been reported so far. So myelopathies can be a complication of metastatic cancers, and it should be considered by health professionals.

Compressive Myelopathy, Spinal Shock, and a Complicated Neurological Exam

The neurological examination, developed and tested since the 1800s has provided physicians with a vital tool to rapidly assess and provide clues to many of the pathological processes lurking inside the brain and spinal cord. With the advent of magnetic resonance imaging, physicians are able to visualize the precise location of the abscess before surgical intervention. In this case report, we present a 51-year-old male with an epidural abscess with multifocal compressive myelopathy, resulting in a complicated neurological examination, making localization a diagnostic challenge. With this case, we would like to stress that complicated multifocal lesions of the cord may present with a large variation in examination findings. This patient’s neurological exam was complicated secondary to a ventrally as well as dorsally located epidural abscess with superimposed spinal shock sequelae. We would like to highlight the importance of a thorough history and the neurological examination but also mention some of its limitations. It is crucial to use clinical judgement to navigate the patient’s history, presentation, and examination to accurately diagnose and treat, particularly so in cases involving compressive myelopathies of the spinal cord.

Clinical Factors Influencing the Neurological Recovery of Patients Operated for a Cervical Myelopathy at the Teaching Hospital of Bouake

Introduction: Cervical myelopathy is the most common myelopathy among people over 50 of age. Cervicosteoarthritis is the main etiology. The purpose of this work was to identify clinical factors that may influence neurological recovery in patients undergoing surgery for cervical myelopathy in our work setting. Materials and Methods: We performed a retrospective analytical study on patients operated on for cervical myelopathy at the teaching hospital of Bouake. The logistic regression model was used to identify the factors influencing post-operative neurological recovery. Results: 50 patients’ records have been enrolled in this study. The mean age of our patients was 53 years with extremes ranging from 25 to 78 years and 39 of our patients (62%) were male. The mean modified pre-operative JOA score was 11.62 versus 12.94 after the surgery. Age, sex, the number of levels operated on and the duration of the evolution of the signs showed no significant link with neurological recovery. Preoperative mild myelopathy (P = 0.0491) and post-operative functional rehabilitation (P = 0.0459) were identified as factors favouring neurological recovery after cervical myelopathy surgery. Conclusion: The good conducts of functional rehabilitation sessions as well as a mild myelopathy were the factors favouring neurological recovery.

Regional gray matter abnormality in hepatic myelopathy patients after transjugular intrahepatic portosystemic shunt: a voxel-based morphometry study

Hepatic myelopathy is a complication seen in patients with chronic liver failure with physiologic or iatrogenic portosystemic shunting. The main symptom is progressive lower limb dyskinesia. The role of the brain motor control center in hepatic myelopathy is unknown. This study aimed to investigate the gray matter changes in patients with hepatic myelopathy secondary to transjugular intrahepatic portosystemic shunt and to examine their clinical relevance. This was a cross-sectional study. Twenty-three liver failure patients with hepatic myelopathy(hepatic myelopathy group), 23 liver failure patients without hepatic myelopathy(non-hepatic myelopathy group) after transjugular intrahepatic portosystemic shunt, and 23 demographically matched healthy volunteers were enrolled from March 2014 to November 2016 at Xijing Hospital, Air Force Military Medical University(Fourth Military Medical University), China. High-resolution magnetization-prepared rapid gradient-echo brain imaging was acquired. Group differences in regional gray matter were assessed using voxel-based morphometry analysis. The relationship between aberrant gray matter and motor characteristics was investigated. Results demonstrated that compared with the non-hepatic myelopathy group, gray matter volume abnormalities were asymmetric, with decreased volume in the left insula(P = 0.003), left thalamus(P = 0.029), left superior frontal gyrus(P = 0.006), and right middle cingulate cortex(P = 0.021), and increased volume in the right caudate nucleus(P = 0.017), corrected with open-source software. The volume of the right caudate nucleus in the hepatic myelopathy group negatively correlated with the lower limb clinical rating of the Fugl-Meyer Assessment(r = –0.53, P = 0.01). Compared with healthy controls, patients with and without hepatic myelopathy exhibited overall increased gray matter volume in both thalami, and decreased gray matter volume in both putamen, as well as in the globus pallidus, cerebellum, and vermis. The gray matter abnormalities we found predominantly involved motor-related regions, and may be associated with motor dysfunction. An enlarged right caudate nucleus might help to predict weak lower limb motor performance in patients with preclinical hepatic myelopathy after transjugular intrahepatic portosystemic shunt. This study was approved by the Ethics Committee of Xijing Hospital, Air Force Military Medical University(Fourth Military Medical University), China(approval No. 20140227-6) on February 27, 2014.

Management of surgical splenorenal shunt-related hepatic myelopathy with endovascular interventional techniques

We present a case with hepatic myelopathy(HM) due to a surgical splenorenal shunt that was successfully treated by endovascular interventional techniques.A 39-year-old man presented with progressive spastic paraparesis of his lower limbs 14 mo after a splenorenal shunt.A portal venogram identified a widened patent splenorenal shunt.We used an occlusion balloon catheter initially to occlude the shunt.Further monitoring of the patient revealed a decrease in his serum ammonia level and an improvement in leg strength.We then used an Amplatzer vascular plug(AVP) to enable closure of the shunt.During the follow up period of 7 mo,the patient experienced significant clinical improvement and normalization of blood ammonia,without any complications.Occlusion of a surgically created splenorenal shunt with AVP represents an alternative therapy to surgery or coil embolization that can help to relieve shunt-induced HM symptoms.

Mechanical and cellular processes driving cervical myelopathy

Cervical myelopathy is a well-described clinical syndrome that may evolve from a combination of etiological mechanisms. It is traditionally classified by cervical spinal cord and/or nerve root compression which varies in severity and number of levels involved. The vast array of clinical manifestations of cervical myelopathy cannot fully be explained by the simple concept that a narrowed spinal canal causes compression of the cord, local tissue ischemia, injury and neurological impairment. Despite advances in surgical technology and treatment innovations, there are limited neuro-protective treatments for cervical myelopathy, which reflects an incomplete understanding of the pathophysiological processes involved in this disease. The aim of this review is to provide a comprehensive overview of the key pathophysiological processes at play in the development of cervical myelopathy.

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.

Application of magnetic resonance imaging in cervical spondylotic myelopathy

Cervical spondylotic myelopathy(CSM) is the most common cause of spinal cord dysfunction and is caused by static or dynamic repeated compression of the spinal cord resulting from degenerative arthritis of the cervical spine and some biological injuries to the cervical spine. The T2 signal change on conventional magnetic resonance imaging(MRI) is most commonly associated with neurological deficits. Diffusion tensor imaging and MR spectroscopy show altered microstructure and biochemistry that reflect patient-specific pathogenesis and can be used to predict neurological outcome and response to intervention. Functional MRI can help to assess the neurological functional recovery after decompression surgery for 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.

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis:A case report

BACKGROUND Hepatic myelopathy(HM)is a rare neurological complication of advanced cirrhosis.Prognosis of patients with HM is generally poor without timely liver transplantation or interventional therapy.Self-resolving HM in patients with alcoholic cirrhosis has never been reported.CASE SUMMARY A 53-year-old man with alcoholic cirrhosis and recurrent overt hepatic encephalopathy for 1 year was admitted for lower extremity weakness,slow movement,and stumbling gait.The patient was diagnosed with HM after excluding other causes of spastic paraparesis.The patient refused liver transplantation.However,the patient kept total abstinence and received a multidisciplinary treatment for complications of decompensated cirrhosis.The symptoms of HM resolved gradually after 2 years of treatment.All complications of alcoholic cirrhosis resolved after 4 years of follow-up.CONCLUSION The case demonstrates that HM can resolve in patients without liver transplantation after total abstinence and systemic management of complications.

Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature

Dural arteriovenous fistula(DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. We present two cases of DAVF presenting as rapidly progressive myelopathy. Two treatment options are available: microsurgical interruption of the fistula and endovascular embolization. These treatment options of DAVFs have improved significantly in the last decade. The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. However, despite treatment a high percentage of patients are still left with severe disability. The potential for functional ambulation in patients with DAVF is related to the time of intervention. This emphasizes the important of early diagnosis and early intervention in DAVF. The eventual outcome may depend on several factors, such as the duration of symptoms, the degree of disability before treatment, and the success of the initial procedure to close the fistula. The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. If intervention is delayed even prolonged time in rehabilitation does not change the grave prognosis. This review outlines the presentation, classication and management of DAVF as well as discussing patient outcomes.

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.

Effect of Exercise Program on the Rehabilitation of Patients with Cervical Spondylotic Myelopathy

Study Design: A clinical trial of 30 consecutive patients with cervical spondylotic myelopathy (CSM). Objectives: To evaluate the effect of directed physical exercise in patients with CSM and to measure severity of myelopathy before and after an exercise program. Setting: Christian Medical College and Hospital, India. Participants: Thirty patients with CSM (mean age-54.1 years) with Nuricks Grade 2 and 3. Background: Myelopathy of the spinal cord can be caused by degenerative process of the cervical vertebrae and it is the most common type of dysfunction of the spinal cord in adult population. CSM usually develops insidiously and the natural history is not well understood, there is debate over the indication for operative Vs non operative management. Method: Patients participated in a 6-week exercise program, consisting of active exercises to upper and lower extremities, scapulothoracic muscles, and gentle stretches, sub maximal isometric exercises of the deep neck flexors, relaxation and immobilization with a cervical collar. Main Outcome Measures: The mJOA (modified Japanese orthopaedic association score) and ASIA motor and sensory scoring. The results were processed by using Wilcoxon sign rank test. Results: After comparing the values at the beginning and end of the program a satisfactory neurological result (sensorimotor/motor and sensory) was obtained in all thirty patients. Conclusion: The exercise program had a positive impact for most of the variables of the study. Exercise intervention with neck immobilization may be a treatment of choice in early stages of CSM. Future randomized controlled studies would provide insight into the effectiveness and clinical relevance of this intervention.

Efficacy of Modified Expansive Open-Door Laminoplasty for Cervical Myelopathy

Objectives: Expansive open-door laminoplasty is used widely for the treatment of cervical spondylosis and Ossification of the Posterior Longitudinal Ligament (OPLL). We have developed a unique modification of the surgical procedure to keep the lamina expanded, with the aim of preventing reclosure of the vertebral arch. To examine the effectiveness of and problems associated with the modified expansive open-door laminoplasty technique developed at our institution by evaluating the surgical outcomes. Methods and Materials: Fifty-six patients (46 men and 10 women) underwent the modified expansive open-door laminoplasty and were followed up for at least 1 year. Thirty-eight had Cervical Spondylotic Myelopathy (CSM) and 18 had OPLL. The patients were 34 to 89 years of age (mean: 60.9 years). The severity of myelopathy was evaluated according to the Japanese Orthopaedic Association’s scoring system. Surgical outcomes were evaluated using Hirabayashi’s system for determining recovery rate. In the radiographic analysis, the following angles were measured before and after surgery: lordosis angle and Range of Motion (ROM) at C2 - C7 on lateral radiographs, and opening angle on computerized tomography (CT). The presence and absence of axial pain and postoperative C5 palsy were also evaluated. Results: The rate of JOA score improvement was about 60%, the lordosis angle observed on lateral radiographs was maintained. ROM decreased after surgery in both the CSM and OPLL groups, and the extent of the decrease was similar to that in previous reports. The opening angle of the lamina was 62°- 65° on post-operative CT. Axial pain was reported by 34% of patients. Conclusions: Our modified procedure produced satisfactory postoperative outcomes based on the clinical data and imaging findings for both CSM and OPLL. The advantage of this procedure is that it avoids potential complications associated with bone grafts or implants.

The Surgical Approaches of Cervical Spondylotic Myelopathy and the Predictive Factors for the Surgical Outcomes

Objective To explore the efficacy and safety of different surgical approaches of cervical spondylotic myelopathy, and the predictive factors for the outcome of surgery. Methods Clinical data of 68 consecutive patients who underwent surgical treatment from 2003-08-01 to 2006-12-01 were collected. The quantization of the efficacy of operation was made by applying Japanese Orthopedic Association (JOA) scoring system, based on which the recovery rate and satisfaction rate were calculated. In the patients who underwent anterior approach, we compared the recovery rate among the subgroups of different duration of symptoms, age at surgery and the severity of diseases. Any surgery-related complications were also noted. Results 73.5% (50/68) patients underwent anterior approach, with an average recovery rate of (68.21 ± 10.06)% and the satisfaction rate of 88.00%;20.6% patients (14/68) underwent posterior approach, with an average recovery rate of (64.03 ± 7.07)% and the satisfaction rate of 100%. The recovery rate had no significant difference in the two approaches. Only 4 patients (5.9%) underwent anterior and posterior combined approach, and the recovery rate and the satisfaction rate were 65.10% and 100%, respectively. In the group of patients who accepted anterior approach, no significant differences were found in the recovery rates of different age subgroups and different duration of symptom subgroups;the significant differences recovery rates between the moderate and severe subgroups were identified. Minor complications, such as asymptomatic screw misplacement, transient dysphagia/odynophagia, pain related to the donor site and axial syndrome, were observed in a few patients. Conclusion The JOA score can be improved by applying the appropriate approaches and the high recovery and satisfaction rates can be achieved at the same time. The efficacies of anterior and posterior approaches were similar. The complications of surgery were minor. In the patients who underwent anterior approach, the severity of diseases was a predictive factor for the outcome of surgery.

Hepatic myelopathy:Morphology of the thoracic and lumbar cord in liver cirrhosis and non-cirrhosis corpses and comparison of neuron functional protein

The current study demonstrated that injury of the spinal cord lateral funiculus occurs in liver cirrhosis. This study sought to compare the morphology of the thoracic and lumbar cord, the expression of functional proteins, and changes in vessels between liver cirrhosis and non-cirrhosis corpses. Results showed that in the liver cirrhosis group, the hepatic vein expanded, the gastrointestinal tract was full of coagulated blood, blood-stasis was easily seen in the veniplex of the vertebral canal and the lumbar spinal cord, and the cell bodies of the anterior horn in the thoracic and lumbar cord were smaller than those in non-cirrhosis corpses. In addition, nerve cells shrank, Nissl bodies were concentrated with obscured nuclei, and neurofilament and synapsin containing cell bodies of the anterior horn and white matter decreased in the liver cirrhosis group. These experimental findings indicate that abnormal circulation of the spinal cord, resulting from hemodynamic change of cirrhotic portal hypertension, may be the most significant cause of hepatic myelopathy.

Co-expression of HBZ,TAX and FOXp3 and HTLV-1-associated myelopathy/tropical spastic paraparesis development in HTLV-1-infected individuals:A systematic review

Human T-cell lymphotropic virus type 1(HTLV-1)is associated with the development of HTLV-1-associated myelopathy/tropical spastic paraparesis(HAM/TSP).It has been reported that the HTLV-1 proteins(specifically TAX and HBZ)can modulate FOXp3,resulting in an immune imbalance that can favor the progression of HAM/TSP.This review aims to summarize the literature in order to clarify the relationship between the expression of HTLV-1 m RNAs and/or viral proteins(TAX and HBZ)with the expression of mRNA and/or protein FOXp3 and their correlation with HAM/TSP development.This systematic review was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis.The search strategy was performed on the Medical Literature Analysis and Retrieval System Online and Latin American and Caribbean Literature in Health Sciences Platform using subject descriptors.After screening,six articles were included in this review.The studies suggested that TAX and HBZ have a directly proportional correlation with FOXp3 in individuals with HAM/TSP,which also presented an increased expression of FOXp3 compared to asymptomatic controls and/or healthy donors.This systematic review indicates that TAX and HBZ can interact with FOXp3 and that interaction may influence HAM/TSP development.

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