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Subclinical autonomic nervous system dysfunction in compressive cervical myelopathy
G Srihari1, Dhaval Shukla, Bhagvatula Indira Devi
1Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India.
Spine
|December 24, 2010
Summary
Cervical compressive myelopathy (CCM) patients exhibit autonomic nervous system (ANS) dysfunction compared to healthy individuals. Surgery improves some ANS functions, like the 30:15 ratio, but heart rate variability (HRV) remains impaired.
Area of Science:
- Neurology
- Cardiology
- Autonomic Nervous System (ANS) Research
Background:
- Autonomic nervous system (ANS) dysfunction is recognized after traumatic spinal cord injury.
- Limited research exists on ANS dysfunction in noncompressive myelopathy, and none on compressive myelopathies.
- Cervical compressive myelopathy (CCM) is a condition with potential, yet understudied, autonomic involvement.
Purpose of the Study:
- To investigate autonomic functions and heart rate variability (HRV) in patients with CCM.
- To compare autonomic function and HRV findings in CCM patients before and after surgical intervention.
- To establish baseline data on ANS function in CCM for future research and clinical correlation.
Main Methods:
- Laboratory evaluation of autonomic nervous system (ANS) function in 29 adult patients with CCM.
- Comparison of CCM patients with 29 age- and sex-matched healthy controls using conventional autonomic function tests and HRV.
- Statistical analysis including Student t-tests and Chi-square/Fisher exact tests to determine significance at the 5% level.
Main Results:
- CCM patients demonstrated significant differences in deep breathing, Valsalva ratio, 30:15 ratio, and orthostatic blood pressure response compared to controls.
- Post-surgery, significant improvement was observed in the 30:15 ratio, but other autonomic function tests showed no significant change.
- Heart rate variability (HRV) parameters showed a trend towards increased total power and decreased successive RR interval differences, but without statistical significance.
Conclusions:
- Patients with CCM exhibit distinct autonomic nervous system (ANS) dysfunction compared to healthy controls.
- Surgical intervention leads to significant improvement in the 30:15 ratio, indicating partial recovery of autonomic function.
- Impaired HRV indices in CCM patients suggest a loss of variability, with trends indicating potential for recovery post-surgery.
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