Single-centre study comparing surgically and conservatively treated patients with spinal cord herniation and review of the literature.
Brown-Séquard-Syndrome
Functional outcome
Myelon herniation
Myelopathy
Spinal cord herniation
Surgery
Journal
Brain & spine
ISSN: 2772-5294
Titre abrégé: Brain Spine
Pays: Netherlands
ID NLM: 9918470888906676
Informations de publication
Date de publication:
2021
2021
Historique:
received:
31
07
2021
revised:
09
10
2021
accepted:
17
10
2021
entrez:
17
10
2022
pubmed:
18
10
2022
medline:
18
10
2022
Statut:
epublish
Résumé
Spinal cord herniation (SCH) is a rare cause of progressive myelopathy and Brown-Séquard-Syndrome. Evaluation of functional outcome after SCH treatment compared to conservatively treated patients. We retrospectively analysed functional outcome in SCH patients treated between 2009 and 2020. We conducted a systematic search using PubMed, MEDLINE and EMBASE to perform a pooled analysis in SCH patients. Our hospital cohort included 17 patients of which 9 were treated surgically. Mean age was 51.9 years, 58.8% of the patients were female. In 4/9 patients (44.4%) the neurological state remained stable after surgery. Four patients improved (44.4%) and one deteriorated after surgery (11.1%). Conservatively treated patients had a higher deterioration rate on follow-up with 3/8 patients deteriorating (37.5%). In our pooled analysis, 109/145 (75.2%) of patients improved, 32/145 (22.1%) remained stable and 4/145 patients deteriorated (2.8%). Among the available data of nine cohorts, mean recovery rate measured by the JOA score was 36.6% (SD 14.4). In our pooled multivariable model lower preoperative JOA score was associated with worse functional outcome (OR 0.86, 95%CI 0.74-0.99, p = .04). Our data shows that patients who are treated surgically have a higher improvement rate and acceptable perioperative morbidity compared to conservatively treated patients. Lower preoperative JOA score decreases chances of improved functional outcome on follow-up. We therefore advocate early surgery for symptomatic patients. Wait and see appears outdated due to progressive impairment and decreased chances of recovery. However, it is still an option in asymptomatic incidental SCH patients.
Identifiants
pubmed: 36247388
doi: 10.1016/j.bas.2021.100305
pii: S2772-5294(21)00305-2
pmc: PMC9560695
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100305Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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