Dec. 21, 2021
Mayo Clinic is exploring whether a protein might provide an adjunct therapy to help people with cervical spondylotic myelopathy regain function after surgery. The laboratory research could potentially improve outcomes for individuals with this common and debilitating condition.
"Since there is no adjunct treatment right now, all we can do after spinal decompression surgery is hope that patients achieve whatever progress improvement they can. An adjunct therapy is definitely needed," says Kingsley Abode-Iyamah, M.D., a neurosurgeon at Mayo Clinic in Jacksonville, Florida. "We're examining whether a particular protein can help the spinal cord to recover from the injuries caused by chronic compression."
Spinal cord compression
Spinal cord compression
Sagittal MRI shows kinking and compression of the spinal cord at the occipitocervical junction, with the associated cord signal change representing ongoing damage to the spinal cord.
Postoperative resolution
Postoperative resolution
MRI after surgical decompression shows resolution of the degenerative changes that caused compression at the occipitocervical junction.
Cervical spondylotic myelopathy is the leading cause of spinal cord-related disability as people age. The condition can lead to gait instability, weakness, paresthesia, loss of dexterity in the upper extremities and urinary dysfunction. These signs and symptoms are caused by compression of the spinal cord from conditions such as disk degeneration, bulging or herniated disks, and spondylosis. After spinal decompression surgery, up to 25% of patients with cervical spondylotic myelopathy require re-operation for the recurrence of signs and symptoms.
Mayo Clinic's research builds on a discovery by Dr. Abode-Iyamah and colleagues that implicated a genetic mutation in the development and severity of cervical spondylotic myelopathy. Known as Val66Met polymorphism, the mutation is in the brain-derived neurotrophic factor gene — which has been implicated in several neurological and psychological conditions.
"Previous studies have shown that the polymorphism is more common in patients with cervical spondylotic myelopathy than in the general population," Dr. Abode-Iyamah says.
In the current laboratory studies, animal models of cervical spondylotic myelopathy receive a protein-based therapy delivered via nanoparticles. The models are then assessed to determine whether the therapy improves function.
The researchers are also comparing cervical spondylotic myelopathy outcomes for patients with and without the polymorphism. "We believe patients with the mutation may do worse," Dr. Abode-Iyamah says.
This type of work exemplifies Mayo Clinic's commitment to laboratory research that ultimately benefits patient care. Clinicians routinely work with laboratory scientists to promote innovation.
"The close collaboration and resources available not only to laboratory staff but also clinicians allow us to think outside the box and really concentrate on improving patient care," Dr. Abode-Iyamah says.