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    Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques - WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2019) Zileli, Mehmet; Borkar, Sachin A.; Sinha, Sumit; Reinas, Rui; Alves, Oscar L.; Kim, Se-Hoon; Parthiban, Jutty
    Objective: This study presents the results of a systematic literature review conducted to determine most up-to-date information on the natural outcome of cervical spondylotic myelopathy (CSM) and the most reliable diagnostic techniques. Methods: A literature search was performed for articles published during the last 10 years. Results: the natural course of patients with cervical stenosis and signs of myelopathy is quite variable. in patients with no symptoms, but significant stenosis, the risk of developing myelopathy with cervical stenosis is approximately 3% per year. Myelopathic signs are useful for the clinical diagnosis of CSM. However, they are not highly sensitive and may be absent in approximately one-fifth of patients with myelopathy. the electrophysiological tests to be used in CSM patients are motor evoked potential (MEP), spinal cord evoked potential, somatosensory evoked potential, and electromyography (EMG). the differential diagnosis of CSM from other neurological conditions can be accomplished by those tests. MEP and EMG monitoring are useful to reduce C5 root palsy during CSM surgery. Notable spinal cord T2 hyperintensity on cervical magnetic resonance imaging (MRI) is correlated with a worse outcome, whereas lighter signal changes may predict better outcomes. T1 hypointensity should be considered a sign of more advanced disease. Conclusion: the natural course of CSM is quite variable. Signal changes on MRI and some electrophysiological tests are valuable adjuncts to diagnosis.
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    Upper Cervical Spine Trauma: WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2020) Alves, Oscar L.; Pereira, Leopoldina; Kim, Se-Hoon; Grin, Andrey; Shimokawa, Nobuyuki; Konovalov, Nikolay; Zileli, Mehmet
    Craniovertebral junction (CVJ) trauma is a challenging clinical condition. Being a highly mobile functional unit at the junction of the skull and the vertebral column, traumatic events in this area may produce devastating neurological complications and death. Additionally, many of the CVJ traumatic injuries can be left undiagnosed or even raise difficult treatment dilemmas. We present a literature review in the format of recommendations on the diagnosis and management of different scenarios for upper cervical trauma and produce recommendations, which can be applicable to various areas of the globe.
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    Value of Surgery and Nonsurgical Approaches for Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations
    (Korean Spinal Neurosurgery Soc, 2019) Parthiban, Jutty; Alves, Oscar L.; Chandrachari, Komal Prasad; Romani, Premanand; Zileli, Mehmet
    Cervical spondylotic myelopathy (CSM) is a common cause of adult spinal cord dysfunction. Although the therapeutic options for moderate to severe CSM patients have been established well, the existing guidelines for therapeutic decisions in mild cases of CSM are unclear. We present a review of literature on conservative treatment and surgery for CSM and suggest general recommendations applicable in various clinical presentations and in different geographic locations across the globe, with due considerations to available resources and locally prevalent practices.