We are often asked whether you should wear a neck collar after surgery for CSM. Some centres advise it and some do not.
This is a well conducted study, which shows very clearly that the collar offers no benefit on symptoms or recovery after surgery. It reiterates the same message discussion during the Myelopathy.org Patient Information Day.
So if there is no difference, should I wear a collar or not? This will need to be discussed with your surgeon. Whilst there is no benefit in terms of symptoms or recovery, some types of operation for CSM may require a period of stabilisation with a collar. It should be remembered that this study was done in patients undergoing cervical laminoplasty without instrumentation (metal fixation).
1. T.Hida et al. Collar Fixation is not Mandatory after Cervical Laminoplasty: A Randomized Controlled Trial Spine Nov 2016
2. Mark Kotter at the Myelopathy.org Patient Information Day
"The dogma that the central nervous system cannot regenerate is simply not true; we just haven’t figured out how to make it happen yet."
These neurons, and their connections to the spinal cord, do not regenerate. To regenerate specific neurons, we must understand how they are generated in the first place. In other words, we believe that the key to achieving therapeutic regeneration is a clear understanding of development.
How genes are regulated to control corticospinal motor neuron development is just beginning to be understood. One way genes are regulated is by small, non-coding RNAs (microRNAs). Our lab has recently discovered that microRNAs appear to be critical to corticospinal motor neuron development. The members of my lab are investigating the ability of microRNAs to control corticospinal motor neuron development in the embryo, in immature brain cells in the dish, and in stem cells.
Why is this exciting?
Regulation by microRNAs represents an entirely new way of understanding the generation of these important neurons. If we can understand how neurons naturally develop, we will be able to identify targets to stimulate their regeneration.
1) Tharin Lab, University of Stanford
2) S.Tharin et al A microfluidic device to investigate axon targeting by limited numbers of purified cortical projection neuron subtypes. Integr Biol (Camb) Nov 2012
3) Iyer et al. Cervical Spondylotic Myelopathy. Clin Spine Surg. Jun 2016
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