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This comprehensive review article aims to provide some definitive statements on the factors like clinical syndromes, radiological findings, and decompressive surgery, that may influence the outcomes in cervical spinal cord injury management. Literature search on these factors published in the last decade were analyzed and definite statements prepared and voted for consensus opinion by the WFNS Spine Committee members and experts in this field at a meeting in Moscow in June 2019 using Delphi method. This was re-evaluated in a meeting in Pakistan in November 2019. Finally, the consensus statements were brought out as recommendations by the committee to the world literature. Traumatic Spinal Cord Syndromes have good prognosis except in elderly and when the presenting neurological deficit was very poor. Though conservative management provides satisfactory results, results can be improved with surgery when instability and progressive compression was present. Locked facet with spinal cord injury denotes poor prognosis. Magnetic resonance imaging T2 imaging is the essential prognostic indicator that apart from sagittal grade, length of injury, maximum canal compromise, maximum spinal cord compression, axial grading (BASIC) score. Diffusion tensor imaging is the next promising predictor in the pipeline. Decompressive surgery when done earlier especially within 24 hours of injury provides better result and there is no clear evidence to show medical management is better or equivalent to delayed surgical management. Clinical syndromes, radiological syndromes, and surgical decompression have strong impact on the out comes in the management of cervical spinal cord injury. Our comprehensive review and final recommendations on this subject will be of great importance in understanding the complex treatment methods in use.
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This is a review article examining the pharmacologic and regenerative cell therapy for spinal cord injury. A literature search during last 10 years were conducted using key words. Case reports, experimental (nonhuman) studies, papers other than English language were excluded. Up-to-date information on the pharmacologic and regenerative cell therapy for spinal cord injury was reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. Pharmacologic and regenerative cell therapy for spinal cord injury have long been an interest of many experimental and clinical researches. Clinical studies with methylpredinisolone have not shown clear cut benefit. Other drugs such as Rho inhibitor, minocycline, riluzole, granulocyte colony-stimulating factor have also been tried without significant benefits. Regenerative cell therapy using different types of stem cells, different inoculation techniques, and scaffolds have undergone many trials highlighting the efficacies of cells and their limitations. This review article summarizes the current knowledge on pharmacologic and regenerative cell therapy for spinal cord injury. Unfortunately, there is a need for further experimental and human trials to recommend effective pharmacologic and regenerative cell therapy.
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To formulate specific guidelines for the recommendation of subaxial cervical spine injuries concerning classification, management, posttraumatic locked facets and vertebral artery injury. Computerized literature was searched on PubMed and google scholar database from 2009 to 2020. For classification, keywords “Sub Axial Cervical Spine Classification,” resulting in 22 articles related to subaxial cervical spine injury classification system (SLICS) system and 11 articles related to AO (Arbeitsgemeinschaft für Osteosynthesefragen, German for “Association for the Study of Internal Fixation”) Spine system. The literature search yielded 210 and 78 articles on “management of subaxial cervical spine injuries” and the role of “SLICS” and “AO Spine” respectively. Keywords “management of traumatic facet locks” were searched and closed reduction, traction, approaches and techniques were studied. “Vertebral artery injury and cervical fracture” exhibited 2,328 references from the last 15 years. The objective was to identify the appropriate diagnostic tests and optimal treatment. Up-to-date information was reviewed, and statements were produced to reach a consensus in 2 separate consensus meetings of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Based on the most relevant literature, panelists in Moscow consensus meeting conducted in May 2019 drafted the statements, and after a preliminary voting session, the consensus was identified on various statements. Another meeting was conducted at Peshawar in November 2019, where in addition to previous statements, few other statements were discussed and voted. Specific recommendations were then formulated guiding classification, management, locked facets and vertebral artery injuries. This review summarizes the WFNS Spine Committee recommendations on subaxial cervical spine injuries.
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Objective This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques.
Methods A literature search was performed for articles published during the last 10 years.
Results The natural course of patients with cervical stenosis and signs of myelopathy is quite variable. In patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. The electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). The differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease.
Conclusion The natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.
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This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick’s grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski’s sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.
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Advancing Precision Medicine in Degenerative Cervical Myelopathy Abdul Al-Shawwa, David W. Cadotte Journal of Clinical Medicine.2025; 14(23): 8344. CrossRef
Symptom Duration as a Predictor of Neurological Recovery After Decompression Surgery for Degenerative Cervical Myelopathy Yazan Noufal, Felix Schmitz, Marcus Richter, Philipp Hartung, Philipp Drees, Yama Afghanyar, Martin Naisan Cureus.2025;[Epub] CrossRef
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T2-weighted Imaging Hyperintensity and Transcranial Motor-evoked Potentials During Cervical Spine Surgery: Effects of Sevoflurane in 150 Consecutive Cases Nicole LeClair, Milca Ejimone, Davene Lynch, Jayanth Dasika, Dinesh Rao, Amie L. Hoefnagel, Paul D. Mongan Journal of Neurosurgical Anesthesiology.2024; 36(2): 150. CrossRef
Clinical outcome of surgical management of mild cervical compressive myelopathy based on minimum clinically important difference Hiromichi Hirai, Takashi Fujishiro, Yoshiharu Nakaya, Sachio Hayama, Yoshitada Usami, Masahiro Mizutani, Atsushi Nakano, Masashi Neo The Spine Journal.2024; 24(1): 68. CrossRef
Diagnostic and prognostic significance of preoperative evoked potential tests in degenerative cervical myelopathy Dongwoo Yu, Min Cheol Chang, Ikchan Jeon, Sang Woo Kim The Spine Journal.2024; 24(1): 87. CrossRef
Development of the cervical myelopathy severity index: a new patient reported outcome measure to quantify impairments and functional limitations Armaan K. Malhotra, Yingshi He, Erin M. Harrington, Blessing N.R. Jaja, Mary P. Zhu, Husain Shakil, Nicolas Dea, Michael H. Weber, Najmedden Attabib, Philippe Phan, Yoga Raja Rampersaud, Jerome Paquet, W. Bradley Jacobs, David W. Cadotte, Sean D. Christie The Spine Journal.2024; 24(3): 424. CrossRef
Classification and prognostic factors of patients with cervical spondylotic myelopathy after surgical treatment: a cluster analysis Xiao Fan, Rui Chen, Haoge Huang, Gangqiang Zhang, Shuai Zhou, Xin Chen, Yanbin Zhao, Yinze Diao, Shengfa Pan, Fengshan Zhang, Yu Sun, Feifei Zhou Scientific Reports.2024;[Epub] CrossRef
Influence of Blood Pressure on Acute Cervical Spinal Cord Injury Without Fracture and Dislocation: Results From a Retrospective Analysis Duo Zhang, Bowei Xiao, Baoge Liu, Wei Cui, Shuo Duan, Bingxuan Wu, Lei Wang, Di Zhu, Tianhua Rong World Neurosurgery.2024; 184: e530. CrossRef
Is Upper Extremity or Lower Extremity Function More Important for Patient Satisfaction? An Analysis of 24-Month Outcomes from the QOD Cervical Spondylotic Myelopathy Cohort Eunice Yang, Praveen V. Mummaneni, Dean Chou, Chiemela Izima, Kai-Ming Fu, Mohamad Bydon, Erica F. Bisson, Christopher I. Shaffrey, Oren N. Gottfried, Anthony L. Asher, Domagoj Coric, Eric Potts, Kevin T. Foley, Michael Y. Wang, Michael S. Virk, John J. K Clinical Spine Surgery.2024; 37(4): 188. CrossRef
A comparison of clinical and radiological outcomes following laminectomy and laminectomy with fusion in patients of cervical spondylotic myelopathy: A systematic review and meta-analysis Duddukunta Vishal Reddy, Deepankar Satapathy, Balgovind S. Raja, Deepak Kumar Maley, Kaustubh Ahuja, Ranjith Kumar Yalamanchili, Maheshwar Lakkireddy, Syed Ifthekar Neurosurgical Review.2024;[Epub] CrossRef
Diffusion Basis Spectrum Imaging Provides Insights Into Cervical Spondylotic Myelopathy Pathology Justin K. Zhang, Dinal Jayasekera, Chunyu Song, Jacob K. Greenberg, Saad Javeed, Christopher F. Dibble, Jacob Blum, Peng Sun, Sheng-Kwei Song, Wilson Z. Ray Neurosurgery.2023; 92(1): 102. CrossRef
Clinically meaningful improvement in disabilities of arm, shoulder, and hand (DASH) following cervical spine surgery Saad Javeed, Jacob K. Greenberg, Benjamin Plog, Justin K. Zhang, Alexander T. Yahanda, Christopher F. Dibble, Jawad M. Khalifeh, Miguel Ruiz-Cardozo, Raj S. Lavadi, Camilo A. Molina, Paul Santiago, Nitin Agarwal, Brenton H. Pennicooke, Wilson Z. Ray The Spine Journal.2023; 23(6): 832. CrossRef
Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy Victor Hin Ting Yick, Changmeng Zhang, Janus Siu Him Wong, Samuel Yan Lik Ng, Nicholas San Tung Wong, Hongfei Wang, Paul Aarne Koljonen, Graham Ka Hon Shea Journal of Bone and Joint Surgery.2023; 105(3): 181. CrossRef
A Comparison Between Somatosensory Evoked Potentials and Spine MRI in the Diagnosis of Non-compressive Myelopathy: Which Is More Accurate? Haneen J Mohammed, Mazin M Hammady, Farah N Abbas Cureus.2023;[Epub] CrossRef
Utility of MRI in Quantifying Tissue Injury in Cervical Spondylotic Myelopathy Ali Fahim Khan, Grace Haynes, Esmaeil Mohammadi, Fauziyya Muhammad, Sanaa Hameed, Zachary A. Smith Journal of Clinical Medicine.2023; 12(9): 3337. CrossRef
Factors Affecting Surgical Outcomes in Cervical Spondylotic Myelopathy: A Retrospective Study Erhan Çelikoğlu, Hüseyin Demir Istanbul Medical Journal.2023; 24(2): 172. CrossRef
Cervical Spondylotic Myelopathy: From the World Federation of Neurosurgical Societies (WFNS) to the Italian Neurosurgical Society (SINch) Recommendations Francesco Costa, Carla Daniela Anania, Umberto Agrillo, Assietti Roberto, Bernucci Claudio, Bistazzoni Simona, Bongetta Daniele, Brembilla Carlo, Cappelletto Barbara, Cocciaro Ardico, Costella Giovanni Battista, De Falco Raffaele, De Rosa Andrea, Del Vecc Neurospine.2023; 20(2): 415. CrossRef
Does MR Signal Intensity Change have Prognostic Value in Multilevel Cervical Myelopathy? A Single-Center, Prospective Study BharatR Dave, Ajay Krishnan, RaviRanjan Rai, Devanand Degulmadi, Shivanand Mayi, Vikram Patidar Neurology India.2023; 71(2): 285. CrossRef
Cervical muscle morphometry and composition demonstrate prognostic value in degenerative cervical myelopathy outcomes Neda Naghdi, James M. Elliott, Michael H. Weber, Michael G. Fehlings, Maryse Fortin Frontiers in Neurology.2023;[Epub] CrossRef
Investigation of the Efficacy of Bilateral Osteoligamentous Decompression via Hemilaminectomy in Cervical Spondylotic Myelopathy: A Clinical Study Mustafa Ogden, Mustafa Ilker Karagedik, Alemiddin Ozdemir, Ibrahim Umud Bulut, Ahmet Melih Erdogan, Bulent Bakar World Neurosurgery.2023; 180: e560. CrossRef
Spinal Cord Signal Intensity Predicts Functional Outcomes in the Operative Management of Degenerative Cervical Myelopathy Gaylinn Kwame Firempong, William L. Sheppard, Yaroslav Gelfand, Benjamin M. Ellingson, Langston T. Holly Clinical Spine Surgery.2023; 36(10): 438. CrossRef
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Fusion rates for conservative and surgical management of type II odontoid fractures and its impact Lauren Harris, Shahswar Arif, Matthew Elliot, Zarina Brady, Alistair Lawrence, Cheong Lee, Kevin Tsang British Journal of Neurosurgery.2021; 35(5): 607. CrossRef
Increased signal intensity on postoperative T2-weighted axial images in cervical spondylotic myelopathy: Patterns of changes and associated impact on outcomes Tae-Hoon Nam, Joon Woo Lee, Jin S. Yeom, Eugene Lee, Yusuhn Kang, Joong Mo Ahn, Heung Sik Kang Journal of Clinical Neuroscience.2021; 90: 244. CrossRef
Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty Su Hun Lee, Dong Wuk Son, Jun Jae Shin, Yoon Ha, Geun Sung Song, Jun Seok Lee, Sang Weon Lee Journal of Korean Neurosurgical Society.2021; 64(5): 677. CrossRef
Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach Gianpaolo Jannelli, Aria Nouri, Granit Molliqaj, Giovanni Grasso, Enrico Tessitore World Neurosurgery.2020; 140: 541. CrossRef
Nine-segment laminectomy is safe for the resection of a schwannoma extending from C-2 to T-3: a rare case report Mohamad Saekhu, Nuryati Chairani Siregar, Kevin Gunawan, Setyo Widi Nugroho Medical Journal of Indonesia.2020; 29(3): 326. CrossRef
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