This group followed up 135 patients with CSM, of which some patients underwent surgery and some did not. They found that the blood pressure of patients undergoing surgery improved (lowered) after surgery, whereas those who did not, remained the same.
You of course might say, well 'stress and pain' are a result of CSM, surely if they improve after surgery, my blood pressure will go down? Well the group measured pain, and found that the improvement of blood pressure did not relate to pain, but instead severity of CSM...
This puts the cat amongst the pigeons. Why should CSM cause high blood pressure?
That remains an unanswered question. This study did not measure stress, additionally some limitations in the study, particularly the number of patients, may have hidden a relationship with pain.
However there is some theory to the idea that CSM could affect your blood pressure. Control of blood pressure is naturally dependent on many things. Partly it relies on some very small nerve fibres called your 'Sympathetic Nervous System'. Although this nervous system is separate to your spinal cord, there is some communication which could be potentially disrupted in CSM. If we look at patients who have a traumatic spinal cord injury, their blood pressure is often unstable as a result. So there could be something more to this than simply pain or stress! We will have to watch this space! But be prepared to reduce your blood pressure medication after surgery if that is applicable.
What were the researchers looking at and why?
The researchers were investigating the use of a drug called Cilostazol in cervical spondylotic myelopathy (CSM). This drug has been shown to be a safe and effective drug in humans, which can reduce nerve cell damage. The group therefore wanted to test whether this drug can protect nerve cells in CSM.
What did this study show?
Rats with CSM had reduced running ability on a treadmill and reduced grip strength. There was also increased loss of nerve cells. Rats that received the drug Cilostazol had preserved grip strength and running ability. Cilostazol also prevented nerve cell loss.
Cilostazol is a drug, which inhibits the enzyme phosphodiesterase (PDE). PDE normally breaks down a molecule called cyclic adenosine monophosphate (cAMP). cAMP is involved in relaxation of the blood vessels. Cilostazol therefore increases levels of cAMP and causes relaxation of the blood vessels. Cilostazol may therefore improve function in CSM by widening the blood vessels and improving blood flow (Figure 1).
Cilostazol appears to improve function in CSM, however its' mechanism of action in CSM needs to be studied. In particular, its effect on blood flow and whether it does indeed cause widening of the arteries or has other affects must be investigated.
What does this mean for patients with CSM?
As Cilostazol is licensed for use in humans, this drug has huge potential for use in CSM. Its exact mechanism of action and potential side effects in CSM need to be tested.
Yamamoto S, Kurokawa R, Kim P. Cilostazol, a selective Type III phosphodiesterase inhibitor: prevention of cervical myelopathy in a rat chronic compression model Laboratory investigation. J Neurosurg Spine. 2014. 20 (1):93-101.
Proposed mechanism of action of Cilostazol.
This has changed with a study from North America.  They reconfirmed the finding that smokers do not recover as much as non smokers after surgery, but went on to show that this is related to how much you smoke. I.e. The more you smoke, on average, the less you recovery after surgery, currently the only treatment for CSM.
Speaking at the 31st Annual Meeting of the North American Spine Society, David Kusin the lead author suggested smoking limits the natural healing process. The exact way in which smoking impairs recovery is unclear. Some experts believe the affect is due to hardening of the arteries (accelerated by smoking and responsible for conditions such as heart attacks). Their theory is that once the compression is removed, and blood flow returns to support the healing process, in smokers the is less effective.
What ever the exact mechanism, the impact is clear. Smoking is harmful and smoking is something you can change.
1. Kusin et al. The effect of smoking on Spinal Cord Healing following surgical treatment of cervical myelopathy. Spine June 2015
We are committed to raising awareness of CSM. We have been working with Cambridge TV to produce a documentary about the condition. This includes interviews from patients at the September CSM day, hosted at the University of Cambridge. Part 1 aired a few weeks ago, but now Part 2 is ready for viewing. Thanks to all at Cambridge TV for putting together this excellent summary of the disease, its impact and the future of treatment. Hope you enjoy. Let us know what you think!
As we have been reiterating throughout this blog, CSM is massively under-recognised. We are working to raise the profile of the disease, and have been very grateful for the support of Cambridge TV who have made a 2-part documentary about the disease. See part 1 here. This includes interviews of patients and their supporters from our CSM Day at the University of Cambridge
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