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C3-4 level cervical spondylotic myelopathy
K H Vyas1, Deepu Banerji, S Behari
1Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow - 226 014, India.
Neurology India
|July 23, 2004
Summary
Cervical spondylotic myelopathy (CSM) at C3-4 is rare but treatable. Radiological factors like canal diameter and cord compression ratio predict outcomes, with significant improvement noted post-treatment.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Radiology
Background:
- Cervical spondylotic myelopathy (CSM) is a degenerative spinal condition affecting the neck.
- CSM is uncommon at the C3-4 vertebral level, making it a unique area of study.
Purpose of the Study:
- To investigate radiological factors contributing to C3-4 CSM.
- To assess the clinical outcomes of patients treated for C3-4 CSM.
Main Methods:
- Retrospective analysis of 14 patients with C3-4 CSM over 3 years.
- Radiological assessment included static/dynamic canal diameters, retrolisthesis, osteophytes, fusion on X-rays, and antero-posterior cord compression ratio (APCR) on MRI.
- Clinical status evaluated using the modified Japanese orthopedic association scale (mJOAS).
Main Results:
- Significant differences in static and dynamic canal diameters at C3-4 (p < 0.01).
- MRI showed significant C3-4 cord compression (APCR) compared to lower levels.
- Correlation found between APCR and pre-operative mJOAS (r=0.6, p<0.05).
- Mean mJOAS improved from 9.35 to 14.35, with a 66.9% recovery rate.
- Younger patient demographic compared to international literature.
Conclusions:
- Degenerative changes in lower cervical segments can lead to C3-4 spondylotic changes and myelopathy.
- Radiological parameters, particularly APCR, are valuable in assessing C3-4 CSM severity and predicting outcomes.
- Surgical intervention leads to significant clinical improvement in patients with C3-4 CSM.