title: Rapid progressive clinical deterioration of cervical spondylotic myelopathy.
abstract: METHODS
  Retrospective clinical study.
  
  
  OBJECTIVE
  To elucidate the pathophysiology of rapid progressive clinical deterioration following the onset of cervical myelopathy.
  
  
  METHODS
  Spinal Injuries Center, Fukuoka, Japan.
  
  
  METHODS
  A total of 43 cervical spondylotic myelopathy (CSM) patients were treated surgically by a senior surgeon. All patients showed intramedullary intensity changes on magnetic resonance (MR) imaging. Overall, eight patients suffered rapid progressive clinical deterioration; four of them had obvious anamnesis of minor trauma. We assessed the responsible injured segment by MR T2-weighted images. Clinical instabilities at the focal segment were evaluated using functional sagittal plain radiographs. Neurological evaluations were performed preoperatively and at 12 months postoperatively using American Spinal Injury Association (ASIA) motor scores and Japanese Orthopaedic Association (JOA) scores for cervical myelopathy. Intraoperatively, we evaluated the presence of adhesive scar tissue on the dura mater at the focal segment.
  
  
  RESULTS
  The responsible injured segment was C3-4 in 75% of the rapid progressive (rp)-CSM and in 28.57% of the conventional CSM subjects. One with rp-CSM showed sagittal translational segmental instability. Preoperative ASIA motor scores and JOA scores in the rp-CSM were significantly lower than those in the conventional CSM subjects. Postoperative ASIA motor scores between the subjects showed no significant differences; however, postoperative JOA scores in the rp-CSM subjects were significantly lower. Moreover, an epidural membrane was observed in 62.5% of rp-CSM and 11.4% of conventional CSM subjects.
  
  
  CONCLUSIONS
  We hypothesized that the pathophysiology of rp-CSM might be additional cervical cord disorder following the onset of cervical myelopathy. Early decompression surgery is recommended in such patients.
authors.affiliation: Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Morishita
authors.affiliation: Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
authors.forename: A
authors.initials: A
authors.lastname: Matsushita
authors.affiliation: Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ueta
authors.affiliation: Department of Orthopedic Surgery, Fukuoka University, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Naito
authors.affiliation: Department of Orthopedic Surgery, Spinal Injuries Center, Iizuka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shiba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery*; D055009:Spondylosis / Q000209:etiology*; D018709:Statistics, Nonparametric