Cervical Spondylotic Myelopathy: Surgical Results and Factors Affecting Prognosis

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathyscale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre-and postoperatively. The correlation between the scoreresults, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23-37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P \ 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.

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“…Abnormal curvature of the cervical spine was described as a negative predictor for the postoperative recovery by several authors [1, 20,30].…”

Section: Radiological Findingsmentioning

confidence: 99%

Analysis of five specific scores for cervical spondylogenic myelopathy

2007

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“…Cervical spondylotic myelopathy (CSM) and lumbar spinal stenosis are common degenerative spinal diseases among the elderly. Multilevel spinal stenosis and local kyphosis due to progressive disc degeneration are frequently seen in the elderly, exacerbating the condition 5,6) . Patients with advanced CSM tend to fall easily, resulting in them being bedridden or in a wheelchair because of the spinal cord disorder 7) .…”

Section: Introductionmentioning

confidence: 99%

Surgical and general complications in 2,961 Japanese patients with cervical spondylotic myelopathy: Comparison of different age groups

Imajo

Taguchi

Neo

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Details of surgical and general complications for patients with cervical spondylotic myelopathy (CSM) are still uncertain. The purpose of this study was to describe surgeries and their complications among Japanese patients with CSM. Methods: The Japanese Society for Spine Surgery and Related Research performed a nationwide survey on spine surgery and complications in 2011. Data of patients with 2,961 CSM >40 years old were included. The clinicopathological variables were basic demographic and clinical information, surgical information, and surgical and general complications. To examine the influence of age, variables were compared among three age groups: patients 40-64 (n=1,123), 65-74 (n=966), and ! 75 (n=872) years of age. Results: The study included 1,970 males and 991 females and the mean age was 64.3 years old. There were 168 anterior (5.7%) and 2,770 posterior (94.2%) approach surgeries. The vast majority of patients with CSM were treated using the posterior approach, 89.4% of whom had decompression surgery only. Anterior surgeries were more common in the younger age group, but posterior surgeries were equally distributed. The incidence of total complications including surgical/general complications was similar for the anterior (16/168; 9.5%) and posterior (295/2,770; 10.6%) approaches. No patient died on the operating table, but four patients (0.1%) died within one month after surgery. No association was detected between complications and age, comorbidity, and other surgical factors. The incidence of complications was similar for the different age groups. However general complications were predominantly observed in the older group and those who had instrumented surgery. Conclusions: The results indicate that the indication and surgical performance for patients with CSM is favorable in Japan, despite the super-aging population. Few serious complications were reported in this study. However, more detailed informed consent about surgical and, in particular, general complications is necessary for the older patients with CSM.

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“…Nosso trabalho tem o objetivo de difundir uma técnica de aferição da angulação da coluna cervical em pacientes portadores de mielopatia cervical e investigar a presença e incidência da cifose cervical nestes pacientes e se justifica no fato da existência de muitos relatos na literatura nos quais à mielopatia cervical de origem degenerativa leva a maior predisposição a apresentar retificação ou inversão da lordose cervical [11][12][13][14] . Estas alterações angulares podem ocasionar a piora da mielopatia cervical devido ao aumento do estresse mecânico 11 na face anterior da medula espinhal com uma progressão da cifose, levando à falha de enchimento das artérias nutridoras do segmento medular, principalmente em momentos de força em flexão, à redução de fornecimento de sangue e à progressão da lesão para mielomalácia e atrofia da medula espinhal; consequentemente a um pior prognóstico de recuperação neurológica 12,15,16 pós-operatória.…”

Section: Resultsunclassified

Avaliação do tipo de diamante de benzel em pacientes portadores de mielopatia cervical

Rezende¹,

Cardoso²,

Jacob

et al. 2012

Coluna/Columna

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RESUMOObjetivo: Difundir o método de Benzel para aferição da angulação cervical e quantificar a prevalência de cada tipo de diamante de Benzel em 30 pacientes portadores de mielopatia cervical com indicação cirúrgica. Métodos: Estudo retrospectivo de pacientes portadores de mielopatia cervical submetidos a tratamento cirúrgico. Foram analisadas radiografias em perfil da coluna cervical onde se aferiram os tipos diamante de Benzel usando técnicas descritas pelo próprio Benzel. Excluímos do estudo aqueles pacientes que desenvolveram a doença após traumas, que foram submetidos reoperações ou aqueles que não forneceram radiografias em perfil adequadas para aferição. Resultados: Foram avaliados 30 pacientes, sendo 25 deles do sexo masculino, com idade entre 30 e 74 anos (média de 52,4 anos). Após a realização das medidas foram encontrados 24 pacientes com diamantes do tipo A (80%), 2 do tipo B (6,7%) e 4 tipo C (13,3%). Conclusão: O diamante de Benzel tipo "A" foi encontrado em 80% dos pacientes portadores de mielopatia cervical no período pré-operatório.Descritores: Coluna vertebral; Doenças da medula espinal; Cifose; Mielopatia cervical. ABSTRACT Objective: Diffuse the method of benzel for calibration of cervical angulation and to assess the prevalence of each type of benzel's diamond between 30 patients with cervical myelopathy with an indication for surgical treatment. Methods

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Cervical Spondylotic Myelopathy: Surgical Results and Factors Affecting Prognosis

Abstract: It can be concluded that age and abnormal cervical curvature predict less postoperative neurological improvement. The presence of preoperative high signal intensity within the spinal cord may also reflect less neurological improvement.

Cited by 159 publications

References 19 publications

Analysis of five specific scores for cervical spondylogenic myelopathy

Analysis of five specific scores for cervical spondylogenic myelopathy

Surgical and general complications in 2,961 Japanese patients with cervical spondylotic myelopathy: Comparison of different age groups

Avaliação do tipo de diamante de benzel em pacientes portadores de mielopatia cervical

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