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Predictive factors of neurological recovery after chronic craniovertebral brainstem compression

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

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References

  1. Apostolides PJ, Dickman CA, Golfinos JG, Papadopoulos SM, Sonntag VK (1996) Threaded steinmann pin fusion of the craniovertebral junction. Spine 15:1630–1637

    Article  Google Scholar 

  2. Apuzzo ML, Weiss ML, Heiden JS (1978) Transoral exposure of the atlantoaxial region. Neurosurgery 3:201–207

    Article  CAS  PubMed  Google Scholar 

  3. Arvin B, Fournier-Gosselin MP, Fehlings MG (2010) Os odontoideum: etiology and surgical management. Neurosurgery 66(3 Suppl):22–31

    Article  PubMed  Google Scholar 

  4. Benglis D, Levi AD (2010) Neurologic findings of craniovertebral junction disease. Neurosurgery 66(3 Suppl):13–21

    Article  PubMed  Google Scholar 

  5. Choi D, Fox Z, Albert T et al (2015) Prediction of quality of life and survival after surgery for symptomatic spinal metastases: a multicenter cohort study to determine suitability for surgical treatment. Neurosurgery 77(5):698–708

    Article  PubMed  Google Scholar 

  6. Chong S, Shin SH, Yoo H et al (2012) Single-stage posterior decompression and stabilization for metastasis of the thoracic spine: prognostic factors for functional outcome and patients’ survival. Spine J 12:1083–1092

    Article  PubMed  Google Scholar 

  7. Coxe WS, Landau WM (1970) Patterns of Marchi degeneration in the monkey pyramidal tract following small discrete cortical lesions. Neurology 20:89–100

    Article  CAS  PubMed  Google Scholar 

  8. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH (1995) C1-C2 posterior cervical fusion: long–term evaluation of results and efficacy. Neurosurgery 37:688–692

    Article  CAS  PubMed  Google Scholar 

  9. Crockard HA, Pozo JL, Ransford AO, Stevens JM, Kendall BE, Essigman WK (1986) Transoral decompression and posterior fusion for rheumatoid atlanto-axial subluxation. J Bone Joint Surg Br 68:350–356

    Article  CAS  PubMed  Google Scholar 

  10. Kotil K, Kalayci M, Bilge T (2007) Management of cervicomedullary compression in patients with congenital and acquired osseous-ligamentous pathologies. J Clin Neurosci 14:540–549

    Article  PubMed  Google Scholar 

  11. Levi AD, Tator CH, Bunge RP (1996) Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery 38(1):179–185

    Article  CAS  PubMed  Google Scholar 

  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 York

    Google 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 123:257–283

    Article  CAS  PubMed  Google Scholar 

  14. Maier IC, Baumann K, Thallmair M, Weinmann O, Scholl J, Schwab ME (2008) Constraint-induced movement therapy in the adult rat after unilateral corticospinal tract injury. J Neurosci 28:9386–9403

    Article  CAS  PubMed  Google Scholar 

  15. Menezes AH, Van Gilder JC, Graff CJ, McDonnell DE (1980) Craniocervical abnormalities. A comprehensive surgical approach. J Neurosurg 53:444–455

    Article  CAS  PubMed  Google Scholar 

  16. Menezes AH, VanGilder JC, Clark CR, el-Khoury G (1985) Odontoid upward migration in rheumatoid arthritis. An analysis of 45 patients with “cranial settling”. J Neurosurg 63:500–509

    Article  CAS  PubMed  Google Scholar 

  17. Merwin GE, Post JC, Sypert GW (1991) Transoral approach to the upper cervical spine. Laryngoscope 101:780–784

    Article  CAS  PubMed  Google Scholar 

  18. Naderi S, Crawford NR, Song GS, Sonntag VK, Dickman CA (1998) Biomechanical comparison of C1–C2 posterior fixations. Cable, graft, and screw combinations. Spine (Phila Pa 1976) 15:1946–1955

    Article  Google Scholar 

  19. Nishimura Y, Onoe H, Morichika Y, Perfiliev S, Tsukada H, Isa T (2007) Time-dependent central compensatory mechanisms of finger dexterity after spinal cord injury. Science 318(5853):1150–1155

    Article  CAS  PubMed  Google 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 

  21. Steinberger J, Skovrlj B, Lee NJ et al (2016) Surgical morbidity and mortality associated with transoral approach to the cervical spine. Spine (Phila Pa 1976) 41(9):E535–E540

    Article  Google Scholar 

  22. Stovner LJ, Rinck P (1992) Syringomyelia in Chiari malformation: relation to extent of cerebellar tissue herniation. Neurosurgery 31(5):913–917

    Article  CAS  PubMed  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–S54

    Article  Google Scholar 

  24. Wu J, Zheng W, Xiao JR, Sun X, Liu WZ, Guo Q (2010) Health-related quality of life in patients with spinal metastases treated with or without spinal surgery: a prospective, longitudinal study. Cancer 116(16):3875–3882

    Article  PubMed  Google Scholar 

  25. Yang SY, Gao YZ (1999) Clinical results of the transoral operation for lesions of the craniovertebral junction and its abnormalities. Surg Neurol 51:16–20

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

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.

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Authors and Affiliations

  1. Department of Neurosurgery, Fondation Adolphe de Rothschild, 25 Rue Manin, 75019, Paris, France

    Aymeric Amelot & Guillaume Lot

  2. Department of Neurosurgery, Centre Hospitalier Universitaire de Tours, Tours, France

    Aymeric Amelot & Louis-Marie Terrier

Authors
  1. Aymeric Amelot
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  2. Louis-Marie Terrier
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  3. Guillaume Lot
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Correspondence to Aymeric Amelot.

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The authors declare that they have no conflict of interest.

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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.

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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.

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Amelot, A., Terrier, LM. & Lot, G. Predictive factors of neurological recovery after chronic craniovertebral brainstem compression. Acta Neurochir 160, 1243–1250 (2018). https://doi.org/10.1007/s00701-018-3523-y

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  • DOI: https://doi.org/10.1007/s00701-018-3523-y

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