Predictive factors of neurological recovery after chronic craniovertebral brainstem compression

  • Aymeric Amelot
  • Louis-Marie Terrier
  • Guillaume Lot
Original Article - Spine - Other
  • 16 Downloads

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.

Keywords

Craniocervical junction Palsy Predictive factors Franckel score Neurological recovery Surgery 

Notes

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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

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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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryFondation Adolphe de RothschildParisFrance
  2. 2.Department of NeurosurgeryCentre Hospitalier Universitaire de ToursToursFrance

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