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Toronto (Dec. 1, 2015) – Research by Dr. Michael Fehlings, Neurosurgeon, Krembil Neuroscience Centre, has shown that the neuroprotectant drug, riluzole, combined with decompression surgery results in better long-term improvements in forelimb function in cervical spondylotic myelopathy (CSM) animal models than in those only treated with surgery.
The study results, published in the journal Science Translational Medicine, offer a potential complementary treatment to sustain improvements from surgery in patients suffering from compression of the spinal cord.
CSM is a progressive, degenerative condition of the cervical spine and the leading cause of spinal cord impairment in adults over the age of 55 worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM because it not only slows progression of the disease, but can also improve both functional status and quality of life in most patients.
Although surgical decompression is considered the gold standard treatment for CSM, data from a recent clinical trial – the AOSpine North America CSM study – showed a number of patients experienced postoperative decline or continued to exhibit considerable neurological dysfunction six months after surgery. Animal models that replicate the main clinical expressions of the human disease showed similar outcomes.
Given this data, researchers investigated whether a combination therapy strategy of the riluzole drug and surgery could prevent or decrease these complications.
In CSM, chronic compression of the cervical spinal cord is linked with architectural changes to the microvessel network and altered distribution of spinal cord blood flow. When surgery is done to relieve spinal cord compression, Dr. Fehlings' team hypothesized that the significant increase in spinal cord blood flow - where there had previously been none or very little - may actually cause injury to the area (known as neuronal oxidative damage). This damage was the most likely cause of the decline and complications that had been observed in patients.
Riluzole, a sodium glutamate antagonist, has been previously shown in animal research to protect the spinal cord against the harmful effects of increased blood flow by decreasing neuronal oxidative damage.
"We are very encouraged by this study that shows combining riluzole with surgical decompression better protects the function we are able to restore through this procedure," says Dr. Fehlings, principal investigator of the study. "These findings inform and support the 'CSM-Protect' clinical trial, which is currently recruiting patients, and will hopefully lead to improved treatment and outcomes in CSM patients."
Portions of this media release were adapted from the original manuscript: "Riluzole blocks perioperative ischemia-reperfusion injury and enhances postdecompression outcomes in cervical spondylotic myelopathy".
The Krembil Neuroscience Centre (KNC), located at Toronto Western Hospital, is home to one of the largest combined clinical and research neurological facilities in North America. Since opening in 2001, KNC has been recognized as a world leader through its research achievements, education and exemplary patient care. The centre focuses on the advancement, detection and treatment of neurological diseases and specializes in movement disorders, dementias, stroke, spinal cord injury, blinding eye diseases, epilepsy and cancer-related conditions. For more information please visit
University Health Network consists of Toronto General and Toronto Western Hospitals, the Princess Margaret Cancer Centre, and Toronto Rehabilitation Institute. The scope of research and complexity of cases at University Health Network has made it a national and international source for discovery, education and patient care. It has the largest hospital-based research program in Canada, with major research in cardiology, transplantation, neurosciences, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. University Health Network is a research hospital affiliated with the University of Toronto.
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