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Öğe 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, JuttyObjective: 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.Öğe Epidemiology,natural course, and preventive measures of osteoporotic vertebral fractures: WFNS Spine Committee Recommendations(Edizioni Minerva Medica, 2022) Zileli, Mehmet; Fornari, Maurizio; Costa, Francesco; Anania, Carla D.; Parthiban, Jutty; Sharif, SalmanINTRODUCTION: This review aims to search for up-to-date information on epidemiology, natural course, and preventive measures of osteoporotic spine fractures. EVIDENCE ACQUISITION: We reviewed the literature of the last ten years using keywords natural course and osteoporotic vertebral fractures, epidemiology and osteoporotic vertebral fractures and prevention and osteoporotic vertebral fractures. We then discussed the search results to reach an agreement in two consensus meetings on January and February 2021 of the World Federation of Neurosurgical Societies (WENS) Spine Committee. Finally, we utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized seven papers on the natural course, 15 articles on epidemiology, and 84 papers on preventing osteoporotic vertebral fractures. Finally, the consensus results after voting are presented. EVIDENCE SYNTHESIS: Natural course of acute osteopomtic vertebral fractures is benign; many patients may have sufficient pain relief during the first three months with conservative treatment. At the end of one year of conservative treatment, 40% may still have pain with VAS-scores >= 4. Since the populations are aging, the incidence of OVF continues to rise. Although the prevalence varies across the globe, the highest rates are from North America and some countries of Asia. Preventive treatment of OVF must involve an active lifestyle, adequate nutrition, prevention of immobilization with physical therapy. and pharmacological therapy. Oral calcium and vitamin D are first-line interventions to prevent the bone mass loss, especially in postmenopausal women. There are many pharmacological treatment options: the decision must be made by fracture risk assessment (clinical factors + BMD + BMI) alone or along with DXA (dual-energy X-ray absorptiometry) or history of previous fragility fractures. The indication of one respect to the others is based on patient preference, compliance, and risk of discontinuation related to adverse events and administration method. CONCLUSIONS: The incidence of osteopomtic vertebral fractures increases with age and other factors. The natural course shows that most patients benefit from conservative therapy without any surgical intervention during the first three months. Preventive measures must include active lifestyle, adequate nutrition, prevention of immobilization with physical therapy, oral calcium, and vitamin D intake, and pharmacological therapy after fracture risk assessment.Öğe Osteoporotic vertebral fractures: radiologic diagnosis, clinical and radiologic factors affecting surgical decision making: WFNS spine committee recommendations(Edizioni Minerva Medica, 2022) Sih, Ibet M.; Shimokawa, Nobuyuki; Zileli, Mehmet; Fornari, Mauricio; Parthiban, JuttyINTRODUCTION: With the varied literature on osteoporotic vertebral fracture that may predispose to diagnostic and management dilemma, it is timely to evaluate and streamline the evidence. The aim of this review is to create recommendations on osteoporotic vertebral fractures regarding radiologic diagnosis, and clinical and radiological factors affecting surgical decision making. EVIDENCE ACQUISITION: A computerized literature search was done using PubMed, Google scholar and Cochrane Database of Systematic Reviews from 2010 to 2020. For radiologic diagnosis, the keywords osteoporotic vertebral fractures and radiologic diagnosis were used yielding 394 articles (19 relevant articles). For clinical and radiological factors affecting surgical decision making, the keywords osteoporotic vertebral fractures, radiologic diagnosis, and surgery were used yielding 568 articles (25 relevant articles). EVIDENCE SYNTHESIS: All pertinent data were reviewed, and consensus statements were obtained in two virtual separate consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine committee. The statements were voted and yielded positive or negative consensus using the Delphi method. CONCLUSIONS: This review summarizes the WFNS Spine Committee recommendations on the radiologic diagnosis, and clinical and radiological factors affecting surgical decision making of osteoporotic vertebral fractures.Öğe Osteoporotic vertebral fractures: WFNS Spine Committee Recommendations(Edizioni Minerva Medica, 2022) Zileli, Mehmet; Fornari, Maurizio; Parthiban, Jutty; Sharif, Salman[No Abstract Available]Öğe Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations(Korean Spinal Neurosurgery Soc, 2019) Zileli, Mehmet; Maheshwari, Shradha; Kale, Shashank Sharad; Garg, Kanwaljeet; Menon, Sajesh K.; Parthiban, JuttyThis study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. the predictive variables affecting the outcomes are hand atrophy, leg spasticity, Bonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. the most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.Öğe Outcomes of Spinal Cord Injury: WFNS Spine Committee Recommendations(Korean Spinal Neurosurgery Soc, 2020) Parthiban, Jutty; Zileli, Mehmet; Sharif, Salman YousufThis comprehensive review article aims to provide some definitive statements on the factors like clinical syndromes, radiological findings, and decompressive surgery, that may influence the outcomes in cervical spinal cord injury management. Literature search on these factors published in the last decade were analyzed and definite statements prepared and voted for consensus opinion by the WFNS Spine Committee members and experts in this field at a meeting in Moscow in June 2019 using Delphi method. This was re-evaluated in a meeting in Pakistan in November 2019. Finally, the consensus statements were brought out as recommendations by the committee to the world literature. Traumatic Spinal Cord Syndromes have good prognosis except in elderly and when the presenting neurological deficit was very poor. Though conservative management provides satisfactory results, results can be improved with surgery when instability and progressive compression was present. Locked facet with spinal cord injury denotes poor prognosis. Magnetic resonance imaging T2 imaging is the essential prognostic indicator that apart from sagittal grade, length of injury, maximum canal compromise, maximum spinal cord compression, axial grading (BASIC) score. Diffusion tensor imaging is the next promising predictor in the pipeline. Decompressive surgery when done earlier especially within 24 hours of injury provides better result and there is no clear evidence to show medical management is better or equivalent to delayed surgical management. Clinical syndromes, radiological syndromes, and surgical decompression have strong impact on the out comes in the management of cervical spinal cord injury. Our comprehensive review and final recommendations on this subject will be of great importance in understanding the complex treatment methods in use.Öğe Pharmacologic and Regenerative Cell Therapy for Spinal Cord Injury: WFNS Spine Committee Recommendations(Korean Spinal Neurosurgery Soc, 2020) Takami, Toshihiro; Shimokawa, Nobuyuki; Parthiban, Jutty; Zileli, Mehmet; Ali, SheenaThis is a review article examining the pharmacologic and regenerative cell therapy for spinal cord injury. A literature search during last 10 years were conducted using key words. Case reports, experimental (nonhuman) studies, papers other than English language were excluded. Up-to-date information on the pharmacologic and regenerative cell therapy for spinal cord injury was reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. Pharmacologic and regenerative cell therapy for spinal cord injury have long been an interest of many experimental and clinical researches. Clinical studies with methylpredinisolone have not shown clear cut benefit. Other drugs such as Rho inhibitor, minocycline, riluzole, granulocyte colony-stimulating factor have also been tried without significant benefits. Regenerative cell therapy using different types of stem cells, different inoculation techniques, and scaffolds have undergone many trials highlighting the efficacies of cells and their limitations. This review article summarizes the current knowledge on pharmacologic and regenerative cell therapy for spinal cord injury. Unfortunately, there is a need for further experimental and human trials to recommend effective pharmacologic and regenerative cell therapy.Öğe 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, MehmetCervical 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.Öğe Vertebral augmentation in osteoporotic spine fractures: WFNS Spine Committee recommendations(Edizioni Minerva Medica, 2022) Sharif, Salman; Ali, Muhammad Y.; Costa, Francesco; Zileli, Mehmet; Parthiban, JuttyINTRODUCTION: The aim of this study was to formulate the WFNS Spine Committee guidelines on indications. outcomes, and complications of vertebral augmentation in osteoporotic spine fractures. EVIDENCE ACQUISITION: Computerized literature was searched from 2010 to 2021 using keywords vertebral augmentation, osteoporotic fracture, technique, surgery, complication, and outcome. PubMed yielded 92 articles whereas Google scholar resulted in 120 articles. 29 articles were studied in detail. The studies comprised of seventeen RCT's, two prospective non-randomized studies, three retrospective studies, and seven systematic reviews. The statements were produced to reach a consensus in two separate meetings of WFNS Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. EVIDENCE SYNTHESIS: Drafted statements on Vertebral Augmentation in osteoporotic Spine Fractures were voted upon by expert panelists in Virtual WFNS Spine Committee Consensus Meetings conducted on January 11, 2021, and February 13, 2021. Statements reaching positive consensus provided the basis for the WFNS guidelines regarding vertebral augmentation in osteoporotic spine fractures. CONCLUSIONS: WFNS Spine Committee recommendations on vertebral augmentation in osteoporotic spine fractures are summarized in this article. Vertebral augmentation is superior to conservative treatment for vertebral osteoporotic fractures but has conflicting results on comparison with placebo. Both vertebroplasty and kyphoplasty are equally effective. Most of the studies regarding the efficacy of vertebral augmentation procedures to reduce pain have been largely inconclusive. It is suggested that further high quality, better designed randomized controlled studies are required to establish the role of vertebral augmentation in spine osteoporotic compression fractures.
