Predictive factors of neurological recovery after chronic craniovertebral brainstem compression
- 62 Downloads
Neurologic manifestations of craniovertebral junction (CVJ) disease may generate dramatic brainstem damage, which could evolve to paralysis. In most cases, patients are referred with advanced neurological symptoms such as tetraplegia/paresis. The aim of this study was to identify predictive factors of favorable neurological evolution after non-traumatic brainstem compression.
A prospective study evaluated 143 consecutive patients who had undergone CVJ anterior brainstem decompression. The mean age was 45.1 ± 19.1 years. The study analyzed clinical, surgical, and imagery characters to determine predictive factors of neurological improvement.
The mean follow-up of our series was 10.2 years (range 0.5–23.9). Seventy-one (49.6%) presented initial tetrapalsies resulting from spinal cord compression. Multivariable analysis revealed that Frankel score [odds ratio (OR) 5.7, CI 95% 1.01–31.8; p < 0.04] and preoperative symptoms < 6 months [OR 0.33, CI 95% 0.125–0.9; p < 0.025] were independently associated with partial neurological improvement, while the only independent factor associated with total neurologic recovery was the preoperative symptom evolution <6 months [odd ratio (OR) 4.3, CI 95% 1.6–11.4; p < 0.003]. None of the following were identified as predictive factors: demographic characteristics, medical history, the etiology of compression, or initial spinal cord MRI.
The earlier the decompression is performed, the better the neurological improvement. Whatever the initial Frankel score, if neurological palsy or disorders evolved for less than 6 months, complete recovery is possible.
KeywordsCraniocervical junction Palsy Predictive factors Franckel score Neurological recovery Surgery
We thank Dr. Ann-Rose Cook for sharing her expertise and involvement in helpful discussions, and for the careful and benevolent reviewing of this work.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with human participants performed by any of the authors.
- 12.Levi AD (1998) Neurological syndromes of the craniovertebral junction. In: Dickman CA, Spetzler RF, Sonntag VK (eds) Surgery of the craniovertebral junction. Thieme, New YorkGoogle Scholar
- 13.Liu CN, Chambers WW (1964) An experimental study of the cortico-spinal system in the monkey (Macaca mulatta). The spinal pathways and preterminal distributio of degenerating fibers following discrete lesions of the pre- and postcentral gyri and bulbar pyramid. J Comp Neurol 123:257–283CrossRefPubMedGoogle Scholar
- 20.Smith JS, Shaffrey CI, Abel MF, Menezes AH (2016) Basilar invagination. Neurosurgery 66(3 Suppl):39–47. https://doi.org/10.1227/01.NEU.0000365770.10690.6F Google Scholar
- 23.Wilson JR, Barry S, Fischer DJ et al (2013) Frequency, timing, and predictors of neurological dysfunction in the nonmyelopathic patient with cervical spinal cord compression, canal stenosis, and/or ossification of the posterior longitudinal ligament. Spine (Phila Pa 1976) 38(22 Suppl 1):S37–S54CrossRefGoogle Scholar