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Is decompressive surgery effective for spinal cord sarcoidosis accompanied with compressive cervical myelopathy?
Yoshihito Sakai1, Yukihiro Matsuyama, Shiro Imagama
1Department of Orthopaedic Surgery, Nagoya University School of Medicine, Aichi Prefecture, Japan. jsakai@ncgg.go.jp
Study Design:
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.
Summary Of Background Data:
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).
Conclusion:
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.