The team looked at past medical records and matched together 21 pairs of patients. In each pair, the patients’ age, gender, anaesthetic classification, and operative parameters were the same. The only difference: one of each pair had CSM while the other had CSM and PD. All patients underwent decompressive spinal surgery for their CSM. The researchers subsequently followed-up the patients to see how they fared after surgery. They found that patients with CSM and PD showed similar improvement to CSM patients for most areas; upper limb function, sensory disturbance, and bladder function. However, not with lower limb function. Additionally, overall, patients with PD were less likely to achieve what is referred to as a minimum clinically important difference, i.e. an improvement that is deemed to be worth while.
So, what does this all mean? Well, despite the study’s small sample size, this work suggests that patients with both CSM and PD can benefit from standard CSM surgery, although not always and not to the same extent as those with just CSM. Ultimately, this study calls for further research looking at the interplay between PD and CSM. As in order to best treat patients, CSM doctors must be able to discern the major culprit for the patients’ symptoms and advise patients accurately whether they would benefit from surgery (which is not without risk).
1) Xiao et al. Clinical Outcomes Following Surgical Management of Coexisting Parkinson Disease and Cervical Spondylotic Myelopathy. Neurosurgery Feb 2017
dsMRI is a modified form of the normal imaging technique, first introduced in the 1980s. This form of dynamic MRI imaging can be carried out in the same, standard, MRI machines we use now. Images are still taken with the patient lying down in the scanner (‘supine’), but rather than just take one series of images, the spine is imaged through a range of different neck positions (‘dynamic’), so its effect on the spinal cord can be seen. The major drawer back for patients is the imaging takes even longer (the researchers in this article estimate this would be an additional 15 minutes) and holding the different neck positions may not be possible for patients, as it could exacerbate their symptoms.
Do you suffer from CSM or know someone who does? Then share your experiences to help researchers understand the disease
In this article, the researchers found thirteen previous studies comparing dsMRI to traditional MRI techniques in the diagnosis of CSM. They found that on average, dsMRI was able to identify compression that was either missed or underestimated by traditional techniques in around 20% of patients. This suggests that dsMRI may be able to measure spinal cord compression with a higher degree of sensitivity.
It should be noted that the types of studies conducted so far are at risk of bias which means that the conclusions of this study can only be hesitant. Nevertheless, these findings are interesting as they have identified clear examples of where a standard MRI may not identify any compression, yet dsMRI does. And of course, many doctors rely on ‘MRI compression’ to make their diagnosis.
Additionally given ‘basic’ MRI imaging has been shown to poorly predict the severity of CSM and therefore response to surgery, could dsMRI change this and better inform patients?
One thing is certain, more investigation is required!
(1) Nanfung Xu et al. Does Dynamic Supine Magnetic Resonance Imaging Improve the Diagnostic Accuracy of Cervical Spondylotic Myelopathy? A Review of the Current Evidence, World Neurosurgery http://dx.doi.org/10.1016/j.wneu.2017.01.047.
The latest expert and patient articles