Materiały źródłowe

• #1 Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5532942/

  The ability to preoperatively predict the outcome in cervical spondylotic myelopathy (CSM) helps in planning management and counseling the patient and family. […] The MINPS for CSM is a very practical scale which can be applied easily with the available clinical and radiological data, with good accuracy of outcome prediction. This is the first scale of its kind. […] It has been found that majority of patients with a score of 14 or more improved; those with a score of 9 or less deteriorated; those with a score between 10 and 13 remained static. […] All these prognostic factors have been extensively studied and found to be important in determining the outcome after surgery in CSM. But there is no comprehensive prognostic scale till today, which can objectively predict the outcome in advance. The MINPS has been devised to enable the physician to know the possible outcome after surgery and plan further rehabilitation. The MINPS is very simple, can be routinely applied with the minimum available clinical and radiological information and is readily reproducible. The MINPS has been found to correlate well with outcome: A score of 14 and above, 10-13 and 9 and less, are indicative of improvement, static outcome and deterioration, respectively. MINPS is likely to find wide acceptance and form part of the physician’s armamentarium.

• #2 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. […] Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. […] The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. […] Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. […] Patients with instability are expected to have a poor surgical outcome. […] Spinal cord compression ratio is a critical factor for prognosis. […] High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis.

• #3 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. […] Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. […] The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. […] Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. […] Patients with instability are expected to have a poor surgical outcome. […] Spinal cord compression ratio is a critical factor for prognosis. […] High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis.

• #4

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  To conduct a systematic review of the literature to determine important clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). […] Based on the excellent studies alone, a longer duration of symptoms was associated with a poorer outcome evaluated on both the mJOA/JOA scale and Nurick score. A more severe baseline score was related with a worse outcome only on the mJOA/JOA scale. […] The most important predictors of outcome were preoperative severity and duration of symptoms. This review also identified many other valuable predictors including signs, symptoms, comorbidities and smoking status. […] One of the major findings of this review was that patients with a longer duration of symptoms and a more severe baseline score are more likely to have an unfavorable surgical result.

• #5 Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy in: Journal of Neurosurgery: Spine Volume 11 Issue 2 (2009) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/11/2/article-p112.xml

  The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery. […] Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III). […] Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.

• #6 Does age affect surgical outcomes in patients with degenerative cervical myelopathy? Results from the prospective multicenter AOSpine International study on 479 patients | Journal of Neurology, Neurosurgery & Psychiatry

  https://jnnp.bmj.com/content/87/7/734

  Older age is an independent predictor of functional status in patients with DCM. However, patients over 65 with DCM still achieve functionally significant improvement after surgical decompression. […] In general, older patients have reduced recovery potential following surgery due to comorbidities, diminished physiological reserves and age-related changes to the spinal cord, including a decrease in the number of myelinated fibres in the corticospinal tracts and posterior funiculus. […] After adjustment for these characteristics, differences in functional outcomes between the age groups were still significant. This allows us to conclude that age is an independent predictor of neurological outcome and that the elderly most likely have reduced recovery due to alterations in the composition of their spinal cord and diminished physiological reserves. However, given that surgery remains an effective treatment option for patients at an advanced age.

• #7

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  Although most surgeons will not discriminate on the basis of age, they should be aware that the elderly are not able to translate neurological recovery to functional improvement as well as the younger population. […] Our review determined that factors such as signs (hyperreflexia, leg spasticity and Babinski sign), symptoms (gait impairment, clumsy hands and numbness), comorbidities (diabetes and psychological issues), and smoking status do carry some predictive value. […] The results from this review should encourage further exploration in this area. Even though many studies have examined important predictors of surgical outcome in CSM, there still remains a lack of evidence in the form of high quality, prospective studies using validated outcome measures.

• #8 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. […] Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. […] The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. […] Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. […] Patients with instability are expected to have a poor surgical outcome. […] Spinal cord compression ratio is a critical factor for prognosis. […] High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis.

• #9

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  Although most surgeons will not discriminate on the basis of age, they should be aware that the elderly are not able to translate neurological recovery to functional improvement as well as the younger population. […] Our review determined that factors such as signs (hyperreflexia, leg spasticity and Babinski sign), symptoms (gait impairment, clumsy hands and numbness), comorbidities (diabetes and psychological issues), and smoking status do carry some predictive value. […] The results from this review should encourage further exploration in this area. Even though many studies have examined important predictors of surgical outcome in CSM, there still remains a lack of evidence in the form of high quality, prospective studies using validated outcome measures.

• #10

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  Although most surgeons will not discriminate on the basis of age, they should be aware that the elderly are not able to translate neurological recovery to functional improvement as well as the younger population. […] Our review determined that factors such as signs (hyperreflexia, leg spasticity and Babinski sign), symptoms (gait impairment, clumsy hands and numbness), comorbidities (diabetes and psychological issues), and smoking status do carry some predictive value. […] The results from this review should encourage further exploration in this area. Even though many studies have examined important predictors of surgical outcome in CSM, there still remains a lack of evidence in the form of high quality, prospective studies using validated outcome measures.

• #11 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. […] Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. […] The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. […] Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. […] Patients with instability are expected to have a poor surgical outcome. […] Spinal cord compression ratio is a critical factor for prognosis. […] High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis.

• #12 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  The most important predictors of outcome are preoperative severity and duration of symptoms. […] T2 hyperintensity and cord compression ratio can also predict outcomes. […] Cervical alignment parameters are correlated with general health scores and myelopathy severity. […] Cervical spine kyphosis predicts worse outcomes. […] Instability of the cervical spine is predictive for outcomes. […] Spinal cord compression ratio is a critical factor for prognosis of CSM. […] High signal intensity on T2-weighted MR images is a negative predictor for prognosis.

• #13 Identifying and exploring the favorable factors that help to slow the progression of disease in patients with mild cervical spondylotic myelopathy | Scientific Reports

  https://www.nature.com/articles/s41598-024-69899-y

  To explore the favorable factors that help slow the progression of disease in patients with mild Cervical Spondylotic Myelopathy (CSM). […] A binary logistic regression analysis showed that CL(ROM) and Normal-TA are favorable factors to help slow the progression of disease patients with mild CSM. […] We found that when CL(ROM)39.1 and Normal-TA80.5mm2, the progression of disease in CSM patients may be slower. […] And found that when L213.0, the disease progression of patients may be slower which was superior to calculate CL(ROM) and Normal-TA separately. […] For patients with mild CSM, a small spinal canal and small spinal cord may be favorable factors for their long-term stability. […] Meanwhile, smaller CL(F) and CL(ROM) are also conducive to the long-term stability of the disease. […] The prediction formula: L=CL(ROM)+2.175 * Normal-TA can be obtained.

• #14 The Prediction of Neurological Prognosis for Cervical Spondylotic Myelopathy Using Diffusion Tensor Imaging

  https://www.e-neurospine.org/journal/view.php?number=1357

  Cervical spondylotic myelopathy (CSM) can be easily diagnosed using magnetic resonance imaging (MRI), prediction of surgical effect using preoperative radiological examinations remains difficult. […] The aim of this study was to investigate DTI metrics that are hardly affected by spinal cord compression and can accurately predict neurological status after decompressive surgery. […] In patients with CSM, preoperative LA ratio of AD is seldom affected by spinal cord compression, and it negatively correlates with JOA recovery rate 6 months after surgery. […] Although compressive lesions in patients with CSM affect most preoperative DTI indexes, they seldom affect preoperative AD value. Moreover, preoperative AD value may have a negative correlation with JOA recovery rate 6 months after decompressive surgery; therefore, preoperative AD value may be used to predict postoperative neurological improvement in patients with CSM.

• #15 The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study – MedCrave online

  https://medcraveonline.com/IPMRJ/the-role-of-spared-spinal-cord-in-post-surgery-recovery-depends-on-age-in-cervical-spondylotic-myelopathyndasha-case-series-study.html

  New evidence shows that the degree of microscopic alterations in spinal cord (SC) regions appearing normal on conventional MRI has some predictive value of neurological impairment and recovery in patients with cervical spondylotic myelopathy (CSM). […] Our preliminary results are consistent with MRS potential to assay the degree of microscopic injury and viability of the spared SC to prognosticate functional recovery after decompressive surgery in this population. […] Likewise, our findings provide initial evidence that the contribution of the spared SC in postoperative recovery depends on the patients age at the diagnosis. […] As predicted, NAA and NAA/Cho significantly related to changes in mJOA (p=0.02) and 9HPT (p=0.005) scores respectively. Notably, these relationships did not survive age correction (p=0.1 and p=0.06 respectively).

• #16 The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study – MedCrave online

  https://medcraveonline.com/IPMRJ/the-role-of-spared-spinal-cord-in-post-surgery-recovery-depends-on-age-in-cervical-spondylotic-myelopathyndasha-case-series-study.html

  We found that higher preoperative spinal cord NAA/Cr ratio was associated with higher mJOA scores. […] We also reported that NAA/Cho ratio is stronger and significantly related to the improvement in 9HPT score than the NAA/Cr ratio: a higher preoperative NAA/Cho was associated with greater improvement in time to execute the 9HPT after surgery. […] These findings are consistent with the idea that less microscopic alterations (higher NAA, lower Cho) at a level not directly affected by but closed to the injury are predictive of greater postoperative recovery. […] As predicted, we found that these relationships did not survive the corrections for patients age at the diagnosis. […] Age was deemed an insignificant predictor of clinical changes in our sample (p between 0.2 to 8). This finding is in contrast with prior reports, although not universally accepted, demonstrating that patients age is a major predictor of surgical outcome.

• #17 The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study – MedCrave online

  https://medcraveonline.com/IPMRJ/the-role-of-spared-spinal-cord-in-post-surgery-recovery-depends-on-age-in-cervical-spondylotic-myelopathyndasha-case-series-study.html

  Our results demonstrated that all patients achieved functional improvement after surgery and this was significantly related to the preoperative levels of NAA/Cr and NAA/Cho. […] We advocate that the microcellular information provided by MRS in regions that appear normal on conventional MRI, providing data about distant microscopic effects of the SC damage, may advance our current understanding of why some patients recover while others do not.

• #18 The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study – MedCrave online

  https://medcraveonline.com/IPMRJ/the-role-of-spared-spinal-cord-in-post-surgery-recovery-depends-on-age-in-cervical-spondylotic-myelopathyndasha-case-series-study.html

  We found that higher preoperative spinal cord NAA/Cr ratio was associated with higher mJOA scores. […] We also reported that NAA/Cho ratio is stronger and significantly related to the improvement in 9HPT score than the NAA/Cr ratio: a higher preoperative NAA/Cho was associated with greater improvement in time to execute the 9HPT after surgery. […] These findings are consistent with the idea that less microscopic alterations (higher NAA, lower Cho) at a level not directly affected by but closed to the injury are predictive of greater postoperative recovery. […] As predicted, we found that these relationships did not survive the corrections for patients age at the diagnosis. […] Age was deemed an insignificant predictor of clinical changes in our sample (p between 0.2 to 8). This finding is in contrast with prior reports, although not universally accepted, demonstrating that patients age is a major predictor of surgical outcome.

• #19 Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5532942/

  The ability to preoperatively predict the outcome in cervical spondylotic myelopathy (CSM) helps in planning management and counseling the patient and family. […] The MINPS for CSM is a very practical scale which can be applied easily with the available clinical and radiological data, with good accuracy of outcome prediction. This is the first scale of its kind. […] It has been found that majority of patients with a score of 14 or more improved; those with a score of 9 or less deteriorated; those with a score between 10 and 13 remained static. […] All these prognostic factors have been extensively studied and found to be important in determining the outcome after surgery in CSM. But there is no comprehensive prognostic scale till today, which can objectively predict the outcome in advance. The MINPS has been devised to enable the physician to know the possible outcome after surgery and plan further rehabilitation. The MINPS is very simple, can be routinely applied with the minimum available clinical and radiological information and is readily reproducible. The MINPS has been found to correlate well with outcome: A score of 14 and above, 10-13 and 9 and less, are indicative of improvement, static outcome and deterioration, respectively. MINPS is likely to find wide acceptance and form part of the physician’s armamentarium.

• #20 Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5532942/

  The ability to preoperatively predict the outcome in cervical spondylotic myelopathy (CSM) helps in planning management and counseling the patient and family. […] The MINPS for CSM is a very practical scale which can be applied easily with the available clinical and radiological data, with good accuracy of outcome prediction. This is the first scale of its kind. […] It has been found that majority of patients with a score of 14 or more improved; those with a score of 9 or less deteriorated; those with a score between 10 and 13 remained static. […] All these prognostic factors have been extensively studied and found to be important in determining the outcome after surgery in CSM. But there is no comprehensive prognostic scale till today, which can objectively predict the outcome in advance. The MINPS has been devised to enable the physician to know the possible outcome after surgery and plan further rehabilitation. The MINPS is very simple, can be routinely applied with the minimum available clinical and radiological information and is readily reproducible. The MINPS has been found to correlate well with outcome: A score of 14 and above, 10-13 and 9 and less, are indicative of improvement, static outcome and deterioration, respectively. MINPS is likely to find wide acceptance and form part of the physician’s armamentarium.

• #21 Identifying and exploring the favorable factors that help to slow the progression of disease in patients with mild cervical spondylotic myelopathy | Scientific Reports

  https://www.nature.com/articles/s41598-024-69899-y

  To explore the favorable factors that help slow the progression of disease in patients with mild Cervical Spondylotic Myelopathy (CSM). […] A binary logistic regression analysis showed that CL(ROM) and Normal-TA are favorable factors to help slow the progression of disease patients with mild CSM. […] We found that when CL(ROM)39.1 and Normal-TA80.5mm2, the progression of disease in CSM patients may be slower. […] And found that when L213.0, the disease progression of patients may be slower which was superior to calculate CL(ROM) and Normal-TA separately. […] For patients with mild CSM, a small spinal canal and small spinal cord may be favorable factors for their long-term stability. […] Meanwhile, smaller CL(F) and CL(ROM) are also conducive to the long-term stability of the disease. […] The prediction formula: L=CL(ROM)+2.175 * Normal-TA can be obtained.

• #22 Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy in: Journal of Neurosurgery: Spine Volume 11 Issue 2 (2009) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/11/2/article-p112.xml

  The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery. […] Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III). […] Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.

• #23

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  To conduct a systematic review of the literature to determine important clinical predictors of surgical outcome in patients with cervical spondylotic myelopathy (CSM). […] Based on the excellent studies alone, a longer duration of symptoms was associated with a poorer outcome evaluated on both the mJOA/JOA scale and Nurick score. A more severe baseline score was related with a worse outcome only on the mJOA/JOA scale. […] The most important predictors of outcome were preoperative severity and duration of symptoms. This review also identified many other valuable predictors including signs, symptoms, comorbidities and smoking status. […] One of the major findings of this review was that patients with a longer duration of symptoms and a more severe baseline score are more likely to have an unfavorable surgical result.

• #24 Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6790741/

  The most important predictors of outcome are preoperative severity and duration of symptoms. […] T2 hyperintensity and cord compression ratio can also predict outcomes. […] Cervical alignment parameters are correlated with general health scores and myelopathy severity. […] Cervical spine kyphosis predicts worse outcomes. […] Instability of the cervical spine is predictive for outcomes. […] Spinal cord compression ratio is a critical factor for prognosis of CSM. […] High signal intensity on T2-weighted MR images is a negative predictor for prognosis.

• #25 Clinical prognostic indicators of surgical outcome in cervical spondylotic myelopathy in: Journal of Neurosurgery: Spine Volume 11 Issue 2 (2009) Journals

  https://thejns.org/spine/view/journals/j-neurosurg-spine/11/2/article-p112.xml

  The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery. […] Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III). […] Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.

• #26 The role of spared spinal cord in post-surgery recovery depends on age in cervical spondylotic myelopathy–a case series study – MedCrave online

  https://medcraveonline.com/IPMRJ/the-role-of-spared-spinal-cord-in-post-surgery-recovery-depends-on-age-in-cervical-spondylotic-myelopathyndasha-case-series-study.html

  Our results demonstrated that all patients achieved functional improvement after surgery and this was significantly related to the preoperative levels of NAA/Cr and NAA/Cho. […] We advocate that the microcellular information provided by MRS in regions that appear normal on conventional MRI, providing data about distant microscopic effects of the SC damage, may advance our current understanding of why some patients recover while others do not.

• #27 Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5532942/

  The ability to preoperatively predict the outcome in cervical spondylotic myelopathy (CSM) helps in planning management and counseling the patient and family. […] The MINPS for CSM is a very practical scale which can be applied easily with the available clinical and radiological data, with good accuracy of outcome prediction. This is the first scale of its kind. […] It has been found that majority of patients with a score of 14 or more improved; those with a score of 9 or less deteriorated; those with a score between 10 and 13 remained static. […] All these prognostic factors have been extensively studied and found to be important in determining the outcome after surgery in CSM. But there is no comprehensive prognostic scale till today, which can objectively predict the outcome in advance. The MINPS has been devised to enable the physician to know the possible outcome after surgery and plan further rehabilitation. The MINPS is very simple, can be routinely applied with the minimum available clinical and radiological information and is readily reproducible. The MINPS has been found to correlate well with outcome: A score of 14 and above, 10-13 and 9 and less, are indicative of improvement, static outcome and deterioration, respectively. MINPS is likely to find wide acceptance and form part of the physician’s armamentarium.

• #28

  https://link.springer.com/article/10.1007/s00586-013-2658-z

  Although most surgeons will not discriminate on the basis of age, they should be aware that the elderly are not able to translate neurological recovery to functional improvement as well as the younger population. […] Our review determined that factors such as signs (hyperreflexia, leg spasticity and Babinski sign), symptoms (gait impairment, clumsy hands and numbness), comorbidities (diabetes and psychological issues), and smoking status do carry some predictive value. […] The results from this review should encourage further exploration in this area. Even though many studies have examined important predictors of surgical outcome in CSM, there still remains a lack of evidence in the form of high quality, prospective studies using validated outcome measures.

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