Key result
Surgery for cervical compressive myelopathy is linked to improved autonomic nervous system function.
Why the study?
Does surgery improve autonomic nervous system dysfunction and heart rate variability in patients with compressive cervical myelopathy?
Case-Control (n=58)
Does surgery improve autonomic nervous system dysfunction and heart rate variability in patients with compressive cervical myelopathy?
Patients with compressive cervical myelopathy exhibit subclinical autonomic nervous system dysfunction that partially improves after surgical intervention.
Answers are grounded in this paper and cite their sources.
May warrant autonomic evaluation in myelopathy; hypothesis-generating and requires prospective validation before practice change.
STUDY DESIGN: Laboratory evaluation of autonomic nervous system (ANS) in patients with cervical compressive myelopathy (CCM). OBJECTIVE: To study the autonomic functions and heart rate variability (HRV) in patients with CCM and compare the findings after surgery. SUMMARY OF BACKGROUND DATA: ANS dysfunction is well known after traumatic spinal cord injury. There are very few studies of ANS dysfunction in noncompressive myelopathy and there are no studies on compressive myelopathies. METHODS: After excluding patients on cervical traction or with medical comorbidities, 29 adult patients with CCM were evaluated. Conventional autonomic function tests and HRV were studied in these patients. The same tests were done on 29 age- and sex-matched healthy controls. Student t test was used to find the significance of study parameters on continuous scale. Chi-square/Fisher exact test was used to find the significance of study parameters on categorical scale between two groups. Significance was assessed at 5% level. RESULTS: Patients with CCM as compared with controls, showed significant difference in following parameters; deep breathing, Valsalva ratio, 30:15 (longest RR interval (duration between two consecutive R waves of ECG) around 30th second and the minimum RR interval around 15 seconds after standing up), and orthostatic fall of blood pressure. Except 30:15, there was no significant change of other autonomic function tests after surgery. Among the HRV parameters, there was a trend in increase in total power and decrease in root-mean-square differences of successive RR intervals; however, it did not reach statistical significance. CONCLUSION: Patients with CCM have definite ANS dysfunction as compared to healthy age- and sex-matched controls. There is significant improvement in 30:15 ratio after surgery. HRV indices are also impaired and there is a trend for change in total power and root-mean-square differences of successive RR intervals suggesting loss of HRV.
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Srihari et al. (2010) conducted a case-control in Cervical compressive myelopathy (CCM) (n=58). Cervical compressive myelopathy vs. Age- and sex-matched healthy controls was evaluated on Autonomic function tests and heart rate variability (HRV). Patients with cervical compressive myelopathy exhibited significant autonomic nervous system dysfunction compared to healthy controls, with the 30:15 ratio significantly improving after surgery.
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