|Year : 2019 | Volume
| Issue : 1 | Page : 4
Symposium on cervical spondylo-myelopathy
T Ajoy Prasad Shetty1, Ankur Nanda2
1 Department of Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
2 Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
|Date of Web Publication||11-Jan-2019|
Dr. T Ajoy Prasad Shetty
Ganga Hospital, 313 Mettupalayam Road, Coimbatore - 641 043, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shetty T A, Nanda A. Symposium on cervical spondylo-myelopathy. Indian Spine J 2019;2:4
The term “Degenerative Cervical Myelopathy” is defined as symptomatic cervical myelopathy associated with a broad variety of degenerative changes of the extradural spinal tissues which includes facet joint arthropathy and/or intervertebral disc prolapse, as well as aberration (hypertrophy, calcification, or ossification) in the ligamentum flavum, and/or posterior longitudinal ligament. Cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) are two major conditions under this spectrum.
CSM is the most common cause of nontraumatic spinal cord dysfunction in individuals older than 55 years of age yet many of its aspects related to natural history, management, and outcomes are still not well understood. This symposium of the Indian Spine journal (ISJ) attempts to address all those dilemmas and confusions that exist in a spine surgeons' mind through the authorship of world-class surgeons who not only have tried to update the readers with the current literature evidence but also have shared their personal invaluable experience and insights into the complex problem of CSM.
This symposium is organized with the first presentation focusing mainly on basic science, epidemiology, and natural history. The author, Gautaman Vijay Kumar, emphasizes on the pathophysiology of the disease with particular attention to the biochemical changes occurring at the cellular level which can be correlated with clinical abnormalities. He highlights on the need for a thorough knowledge about the natural history in order to arrive at crucial decisions with regard to operative treatment.
The next two presentations concentrate primarily on clinical and radiological evaluation. Characteristic symptoms such as nondermatomal numbness, loss of manual dexterity in hands and gait instability as well as the various hand myelopathy signs have been discussed in detail by Vivek Josephalong with the newer clinical assessment tools such as 10-s step test and triangle test. However, the role of clinical signs in localizing the level of cord compression still remains inconclusive. The review of imaging studies by Rajasekaran et al. provides additional information to confirm the disease and prognosticate and also to plan intervention with special mention to the role of diffusion tensor imaging.
Biomechanical considerations are critical in decision-making, and the surgical approach is determined by multiple factors such as number of levels involved, sagittal alignment, and instability. The following two papers by Daniel Riew and Shankar Acharya include a thorough review regarding the risks/benefits of anterior versus posterior approaches along with some useful technical tips and tricks which would definitely help the readers in selecting “the right procedure for the right patient.”
OPLL forms an inseparable entity from CSM. Considering its high prevalence in Japan, the next paper is written by Yoshiharu Kawaguchi who gives a comprehensive review on its etiopathogenesis, imaging, and various surgical strategies. We had the opportunity to include the work of Fehling's et al. on surgical and clinical predictors of complications and outcomes in CSM and that forms the final presentation of our symposium. We conclude the session with “ISJ Spine Clinics” which is a case-based discussion conducted by us on various clinical scenarios in day-to-day practice and discuss the possible treatment options.
This symposium explores current approaches in the management of CSM. We hope that it will be interesting and beneficial to any surgeon dedicated to the treatment of CSM by providing relevant information regarding the role of natural history in decision-making, clinicoradiological evaluation in the timing of surgery, biomechanical considerations in surgical techniques and OPLL management, and the outcome predictors in preventing complications.
We would like to personally thank all the contributing symposium authors for their excellent research and the reviewers who critically reviewed all the manuscripts.