Is extensive cervical laminoplasty an effective treatment for spinal cord sarcoidosis combined with cervical spondylosis?
Patients with neurosarcoidosis are usually initially treated with steroid administration even when they have concomitant cord compression on magnetic resonance imaging (MRI). Operative intervention may be indicated in patients with spinal cord sarcoidosis requiring either tissue biopsy for diagnosis or associated with progressive neurologic symptoms. However, there have been no previous reports describing clinical outcomes of laminoplasty for spinal cord sarcoidosis. The objectives of this study are to investigate whether extensive cervical laminoplasty is an effective treatment for spinal cord sarcoidosis combined with spondylotic changes and/or cervical spinal canal stenosis. Open-door laminoplasty was performed in three patients with spinal cord sarcoidosis. All patients received intensive corticosteroid therapy after the operation MRI imaging was performed in all patients before and after the operation. Operative outcomes were not satisfactory and the clinical courses of the patients fluctuated after corticosteroid therapy. Daily life activities were not significantly improved after treatments in any of the three patients, and in the long-term follow-up period the clinical course of one patient was one of inexorable deterioration to a state of quadriplegia. The possibility of spinal cord sarcoidosis should be included in the differential diagnosis, when a distinct high signal intensity area is observed within the spinal cord on T2-weighted MR images in patients with spondylotic changes. Laminoplasty is not an effective intervention for the treatment of spinal cord sarcoidosis even when patients have spondylotic changes and/or a constitutionally narrowing cervical spinal canal. Patients with neurosarcoidosis should be treated first with steroid administration even when they have concomitant cord compression on MRI.
Oe
Keisuke
K
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-Ku, Kobe 650-0017, Japan.
Doita
Minoru
M
Miyamoto
Hiroshi
H
Kanda
Fumio
F
Kurosaka
Masahiro
M
Sumi
Masatoshi
M
D000203:Activities of Daily Living; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods / Q000592:standards; D018450:Disease Progression; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods* / Q000592:standards*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D011788:Quality of Life; D011859:Radiography; D012507:Sarcoidosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D055009:Spondylosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents