Relaxation of the cervical spondylotic myelopethy histodynamic strain: Protocol for a retrospective cohort study addressing differences between anterior and posterior surgical approach.

Completed

• Conditions: Cervical spondylotic myelopathy; Musculoskeletal Diseases

• Registration Number: ISRCTN22078616
• Lead Sponsor: niversity Hospital Centre Zagreb

Brief Summary

Not available

Detailed Description

Not available

Study Timeline

• Study Start: 2016-01-21
• Last Update Posted: 17 October 2016

Recruitment & Eligibility

• Status: Completed
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

1. Clinical inclusion criteria:
CSM classified as Nurick 3-5 in whom left sided C3-C7 open door ECL or ACCF were done for decompression
2. Radiological inclusion criteria were preoperative tethering detected by kMRI 3-D reconstructions. In addition, the patients’ postdecompression spinal cords were untethered, spinal cord shifted backward and the spinal cords dissociated motion from vertebral canal. Spinal cord and brainstem transverse sections obtained from kMRI were used to render 3-D reconstructions of lower part of the brainstem and cervical and upper thoracic spinal cord. Pons to T5/T6 models were used according to the following criteria:
3. Spinal cord tethering: At the point of maximum compression canal compromise is graded 3 (pincer effect); through extension to flexion neck movement the two separate segments of the spinal cord changes the length. Pincer effect divides this two segment.
4. Spinal cord untethering and dissociation of motion: The spinal cord and subarchnoidal space are without compression and therefore graded as 0. The spinal cord homogeneously increases its length from extension to flexion. Preoperative spinal cord 3-D model represents original spinal canal and is compared with postoperative. Dissociation of motion is considered when postoperative 3-D model does not cover pre-opartative, but is shorter and less curly.
5. Backward shift: Preoperative subaxial spinal cord central spline was superposed on the central spline created on the postoperative images. Backward shift is considered when instead of superposing of two lines the postoperative central spline is placed porsterior to the preoperative

Exclusion Criteria

Patients with:
1. Kyphosis more than 10 degrees
2. Instability
3. Metabolic or inflammatory bone disease
4. Tumor
5. Multiple sclerosis
6. Anterolateral sclerosis
7. Toxic-metabolic myelopathies

Study & Design

• Study Type: Observational
• Study Design: Not specified

Primary Outcome Measures

Name	Time	Method
1. Walking track time, assessed as time needed to pass 30 m with one turn, preoperative, follow-up<br>2. Walking track steps, assessed as number of steps needed to pass 30 m with one turn preoperative, follow-up<br>3. Spinal cord length (SCL), assessed as the length of the central spline of the 3-D spinal cord cylinder (SCC) rendered model <br>4. Pia mater envelope area (PEA), assessed as the envelope area of the 3-D SCC rendered model<br><br>Measured before surgery and at follow up.

Secondary Outcome Measures

Name	Time	Method
1. Functional disability, measured by the mJOA grade by 2 independent investigators <br>2. Functional disability, measured by the Nurick scale by 2 independent investigators<br>3. Backward shift, comparing between preop (before surgery) and follow-up MRIs <br>4. Subsidence, comparison between preop and follow-up MRIs <br><br>Measured before surgery and at follow up.