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Cervical and Thoracic Myelopathy
Research Guide
What is Cervical and Thoracic Myelopathy?
Cervical and thoracic myelopathy is spinal cord compression in the cervical or thoracic spine, often due to degenerative changes, disc herniation, or ossification of the posterior longitudinal ligament, leading to neurological deficits such as weakness, sensory loss, and gait disturbance.
The field encompasses 34,226 papers on surgical interventions for cervical and thoracic myelopathy, including anterior cervical discectomy and fusion, laminoplasty, and management of complications like adjacent segment degeneration. Key studies document high rates of asymptomatic degenerative changes detectable by MRI, with Boden et al. (1990) reporting abnormalities in asymptomatic subjects. Procedures like anterior cervical discectomy and fusion show long-term efficacy for radiculopathy and myelopathy, as demonstrated in follow-ups of over 100 patients.
Topic Hierarchy
Research Sub-Topics
Cervical Myelopathy Pathophysiology
This sub-topic investigates the mechanisms of spinal cord compression and dysfunction in cervical myelopathy from degenerative changes. Researchers study neural imaging correlates and natural history progression.
Anterior Cervical Discectomy and Fusion
This sub-topic evaluates outcomes, techniques, and complications of ACDF for radiculopathy and myelopathy. Researchers compare single vs. multi-level fusions and graft options.
Adjacent Segment Degeneration
This sub-topic examines biomechanical and clinical progression of degeneration at segments adjacent to fused levels. Researchers assess risk factors and preventive motion-preserving alternatives.
Ossification of Posterior Longitudinal Ligament
This sub-topic focuses on OPLL epidemiology, surgical strategies like laminoplasty, and postoperative progression in Asian cohorts. Researchers study genetic and radiographic predictors.
Cervical Arthroplasty
This sub-topic compares artificial disc replacement to fusion for preserving motion and reducing adjacent degeneration. Researchers analyze randomized trial data on efficacy and safety.
Why It Matters
Cervical and thoracic myelopathy requires surgical intervention to prevent irreversible neurological damage, with anterior cervical discectomy and fusion providing relief in radiculopathy cases, as shown in Bohlman et al. (1993) where 122 patients underwent the Robinson method with autogenous iliac-crest graft at one to four levels, achieving successful outcomes in long-term follow-up. Adjacent segment disease affects more than one-fourth of patients within ten years post-arthrodesis, particularly at the fifth or sixth cervical vertebra with preexisting degeneration, per Hilibrand et al. (1999). Complications such as postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy occur after anterior cervical discectomy and fusion but are manageable in most cases, according to Fountas et al. (2007). For ossification of the cervical posterior longitudinal ligament causing myelopathy, operative results include progression control in 53 cases, as reported by Hirabayashi et al. (1981). These interventions directly impact patient mobility and quality of life in spine surgery.
Reading Guide
Where to Start
"Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation." by Boden et al. (1990), as it provides foundational evidence of degenerative changes preceding myelopathy, essential for understanding prevalence and natural history.
Key Papers Explained
Boden et al. (1990) establishes high prevalence of asymptomatic cervical degeneration detectable by MRI, setting context for symptomatic myelopathy. Smith and Robinson (1958) and Cloward (1958) introduced anterior discectomy and fusion techniques for disc-related compression, foundational for modern surgery. Bohlman et al. (1993) validates long-term efficacy of the Robinson method in 122 patients. Hilibrand et al. (1999) builds on these by quantifying adjacent segment risks post-fusion. Hirabayashi et al. (1981) addresses ossification-specific myelopathy progression post-laminoplasty.
Paper Timeline
Most-cited paper highlighted in red. Papers ordered chronologically.
Advanced Directions
Research continues to focus on complication rates and adjacent segment disease, with no recent preprints available to indicate shifts. Ongoing analysis of 34,226 papers emphasizes optimizing fusion techniques and graft choices to minimize dysphagia and degeneration.
Papers at a Glance
Frequently Asked Questions
What are common causes of cervical myelopathy?
Degenerative disc disease, disc herniation, and ossification of the posterior longitudinal ligament compress the spinal cord, leading to myelopathy. Boden et al. (1990) found abnormal MRI scans in asymptomatic subjects due to degenerative changes. Hilibrand et al. (1999) identified adjacent segment degeneration post-arthrodesis as a contributor.
How effective is anterior cervical discectomy and fusion for myelopathy?
Anterior cervical discectomy and fusion relieves symptoms in cervical radiculopathy and myelopathy, with Bohlman et al. (1993) reporting successful long-term results in 122 patients using the Robinson method. Fountas et al. (2007) noted manageable complications like dysphagia in their series. Smith and Robinson (1958) established this approach for cervical spine disorders.
What is the risk of adjacent segment disease after cervical fusion?
Symptomatic adjacent-segment disease occurs in more than one-fourth of patients within ten years after anterior cervical arthrodesis. Hilibrand et al. (1999) found higher risk with single-level arthrodesis at C5-C6 and preexisting degeneration. This leads to radiculopathy or myelopathy at adjacent segments.
What complications arise from anterior cervical discectomy and fusion?
Postoperative dysphagia, hematoma, and recurrent laryngeal nerve palsy are the most common complications. Fountas et al. (2007) reported successful management in the vast majority of cases. Autologous iliac crest grafts, used in these procedures, carry additional harvesting risks per Arrington et al. (1996).
How does ossification of the posterior longitudinal ligament cause myelopathy?
Ossification of the cervical posterior longitudinal ligament compresses the spinal cord, causing myelopathy or radiculopathy. Hirabayashi et al. (1981) studied 53 operated cases, noting postoperative progression. Surgical intervention aims to halt neurological deterioration.
What do MRI findings indicate in asymptomatic cervical spines?
Abnormal magnetic-resonance scans occur frequently in asymptomatic subjects due to degenerative disease. Boden et al. (1990) prospectively investigated 63 volunteers, confirming prior radiography and CT findings. These changes precede symptomatic myelopathy.
Open Research Questions
- ? What factors predict progression of ossification of the posterior longitudinal ligament after surgery?
- ? How can adjacent segment degeneration be prevented following anterior cervical arthrodesis?
- ? What is the long-term incidence of myelopathy in patients with asymptomatic cervical MRI abnormalities?
- ? Which surgical approaches best balance decompression and fusion stability in multilevel thoracic myelopathy?
- ? How do iliac crest bone graft complications impact outcomes in cervical fusion for myelopathy?
Recent Trends
The field maintains steady output at 34,226 papers with no reported 5-year growth rate.
Classic papers like Boden et al. (1990, 2472 citations) and Hilibrand et al. (1999, 1661 citations) remain most cited, reflecting enduring focus on degeneration and adjacent segment issues.
No recent preprints or news in the last 12 months indicate stable research without new breakthroughs.
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