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Is decompressive surgery effective for spinal cord sarcoidosis accompanied with compressive cervical myelopathy?
MedLine Citation:
PMID:  20736887     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
STUDY DESIGN: A retrospective multicenter study of series of 12 patients with spinal cord sarcoidosis who underwent surgery.
OBJECTIVE: To evaluate the postoperative outcomes of patients with cervical spinal cord sarcoidosis accompanied with compressive myelopathy and effect of decompressive surgery on the prognosis of sarcoidosis.
SUMMARY OF BACKGROUND DATA: Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease. It is difficult to differentiate spinal cord sarcoidosis from cervical compressive myelopathy. There are no studies regarding the coexistence of compressive cervical myelopathy with cervical spinal cord sarcoidosis and the effect of decompressive surgery.
METHODS: Nagoya Spine Group database included 1560 cases with cervical myelopathy treated with cervical laminectomy or laminoplasty from 2001 to 2005. A total of 12 patients (0.08% of cervical myelopathy) were identified spinal cord sarcoidosis treated with decompressive surgery. As a control subject, 8 patients with spinal cord sarcoidosis without compressive lesion who underwent high-dose steroid therapy without surgery were recruited.
RESULTS: In the surgery group, enhancing lesions on magnetic resonance imaging (MRI) were mostly seen at C5-C6, coincident with the maximum compression level in all cases. Postoperative recovery rates in the surgery group at 1 week and 4 weeks were -7.4% and -1.1%, respectively. Only 5 cases had showed clinical improvement, and the condition of these 5 patients had worsened again at averaged 7.4 weeks after surgery. Postoperative oral steroid therapy was initiated at an average of 6.4 weeks and the average initial dose was 54.0 mg in the surgery group, while 51.3 mg in the nonsurgery group. The recovery rate of the Japanese Orthopedic Association score, which increased after steroid therapy, was better in the nonsurgery group (62.5%) than in the surgery group (18.6%) with significant difference (P < 0.01).
CONCLUSION: The effect of decompression for spinal cord sarcoidosis with compressive myelopathy was not evident. Early diagnosis for sarcoidosis from other organ and steroid therapy should be needed.
Authors:
Yoshihito Sakai; Yukihiro Matsuyama; Shiro Imagama; Zenya Ito; Norimitsu Wakao; Naoki Ishiguro; Hirohisa Watanabe; Fumihiko Kato; Yasutsugu Yukawa; Keigo Ito; Kazuhiro Suzuki; Akiko Tsuboi; Tokumi Kanemura; Go Yoshida
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  35     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-10-26     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E1290-7     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Nagoya University School of Medicine, Aichi Prefecture, Japan. jsakai@ncgg.go.jp
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