Is decompressive surgery effective for spinal cord sarcoidosis accompanied with compressive cervical myelopathy?
METHODS
A retrospective multicenter study of series of 12 patients with spinal cord sarcoidosis who underwent surgery.


OBJECTIVE
To evaluate the postoperative outcomes of patients with cervical spinal cord sarcoidosis accompanied with compressive myelopathy and effect of decompressive surgery on the prognosis of sarcoidosis.


BACKGROUND
Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease. It is difficult to differentiate spinal cord sarcoidosis from cervical compressive myelopathy. There are no studies regarding the coexistence of compressive cervical myelopathy with cervical spinal cord sarcoidosis and the effect of decompressive surgery.


METHODS
Nagoya Spine Group database included 1560 cases with cervical myelopathy treated with cervical laminectomy or laminoplasty from 2001 to 2005. A total of 12 patients (0.08% of cervical myelopathy) were identified spinal cord sarcoidosis treated with decompressive surgery. As a control subject, 8 patients with spinal cord sarcoidosis without compressive lesion who underwent high-dose steroid therapy without surgery were recruited.


RESULTS
In the surgery group, enhancing lesions on magnetic resonance imaging (MRI) were mostly seen at C5-C6, coincident with the maximum compression level in all cases. Postoperative recovery rates in the surgery group at 1 week and 4 weeks were -7.4% and -1.1%, respectively. Only 5 cases had showed clinical improvement, and the condition of these 5 patients had worsened again at averaged 7.4 weeks after surgery. Postoperative oral steroid therapy was initiated at an average of 6.4 weeks and the average initial dose was 54.0 mg in the surgery group, while 51.3 mg in the nonsurgery group. The recovery rate of the Japanese Orthopedic Association score, which increased after steroid therapy, was better in the nonsurgery group (62.5%) than in the surgery group (18.6%) with significant difference (P < 0.01).


CONCLUSIONS
The effect of decompression for spinal cord sarcoidosis with compressive myelopathy was not evident. Early diagnosis for sarcoidosis from other organ and steroid therapy should be needed.
Sakai
Yoshihito
Y
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Aichi Prefecture, Japan. jsakai@ncgg.go.jp
Matsuyama
Yukihiro
Y
Imagama
Shiro
S
Ito
Zenya
Z
Wakao
Norimitsu
N
Ishiguro
Naoki
N
Watanabe
Hirohisa
H
Kato
Fumihiko
F
Yukawa
Yasutsugu
Y
Ito
Keigo
K
Suzuki
Kazuhiro
K
Tsuboi
Akiko
A
Kanemura
Tokumi
T
Yoshida
Go
G
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D016208:Databases, Factual; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013117:Spinal Cord Compression / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D013118:Spinal Cord Diseases / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones