The group looked at their national insurance claims database between 2009 and 2014 for patients undergoing an ACDF for cervical spondylotic radiculopathy or myelopathy. They found that 1.21% of CSM patients at 3 months and 3.34% at 4 years had a further operation. Conversely patients with cervical radiculopathy, the rate was 0.58% at 3 months and 2.06% at 4 years, i.e. lower.
There are some significant limitations to this study, most notably this is only 4 years worth of follow up data and only following an ACDF operation. However in the context of our recent conversations it provides some ballpark figures to consider for an ACDF, a common operation used in the treatment of CSM.
The direct comparison to radiculopathy is also interesting. As a condition with the same degenerative causes (e.g. disc herniation, osteophyte formation etc) this difference raises some interesting discussion points, including are myelopathic patients less tolerant of degeneration? Is radiculopathy an earlier feature of degenerative spine disease?
1. Park et al Spine Reoperation rates after anterior cervical discectomy and fusion for cervical spondylotic radciulopathy and myelopathy Oct 2016
What were the researchers looking at and why?
This group wanted to test whether spinal cord reorganisation plays a role in the recovery following surgical decompression and whether it could be used to find treatments.
What did this study show?
A recent study showed that rats with cervical spondylotic myelopathy (CSM) improved in terms of their function after surgery due spinal cord axons (cords which run from the nerve cells) reorganising themselves and forming new sprouts. Sprouting is when axons develop new endings, which can connect to other healthy parts of the nervous system.
The authors show that after surgery there is also increased formation of synapses. Synapses are junctions between two nerve cells. Information from one nerve cell flows to another nerve cell across a synapse. By increasing sprouting and synapse formation, there is increase in connections between healthy parts of the spinal cord. This allows repair of any damaged areas of the spinal cord and can help restore functional problems.
This study also showed that after surgery there is a reduction in inflammation. Inflammation is a process, which is seen after any injury in the body. It is usually characterized by increase in white blood cells. In CSM, this can contribute to the damage seen. This study showed that after surgery, there is a reduction in inflammation.
Following surgery, there may be reorganization of nerve cells in other parts of the central nervous system, which may contribute to the functional improvement seen. These need to be investigated further.
What does this mean for patients with CSM?
This study is important as it will help researchers look for new treatments. These researchers have shown that ‘sprouting’ appears to be important for functional recovery. This can now be used as a marker for testing drug efficacy in the laboratory!
Dhillon RS, Parker J, Syed YA, et al. Axonal plasticity underpins the functional recovery following surgical decompression in a rat model of cervical spondylotic myelopathy. Acta Neuropathologica Communications. 2016;4(1):89.
Stay tuned for more uploads, including the much anticipated documentary from Cambridge TV.
In a biomechanical study in 2014 Dr Hansrajj demonstrated that the more the neck flexes to look at a mobile phone, the more weight loads through the cervical spine, specifically; 27 pounds, at 30 degrees it’s 40 pounds, at 45 degrees it’s 49 pounds, and at 60 degrees it's 60 pounds! 
Published online, ahead of print, a Swedish group have been following a group of young adults (20-24years old) over the last 5 years.  They assessed a whole host of factors, including their mobile phone usage (e.g. number of text messages sent per day) and presence of muscular pain, such as neck pain. Reassessing this group of almost 8000 young adults periodically over 5 years, they found that overall the presence of neck pain was related to the number of text messages sent. Digging a little deeper into the data, in those young adults who went on to develop neck pain during the study, symptoms were only present after one year and did not persist at 5 years.
These studies are headline grabbing, and we need to be clear - the dots can not yet be connected directly between mobile phone use, wear and tear and subsequent issues like CSM. However the thought process appears to have some logic to it. As we cannot live without mobile phones and technology, whilst we wait for more definitive data to emerge, I suppose its simply 'chin up and text on'.
 Hansrajj KK Surg Technol Int Assessment of stresses in the cervical spine caused by posture and position of the head Jan 2017
 Gustafason E et al Appel Ergon Texting on mobile phones and musculoskeletal disorders in young adults: a five year cohort study. Jan 2017
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