Hatem M I Salem1, Khalid M I Salem1, Filip Burget2, Raj Bommireddy1, Zdenek Klezl3,4. 1. Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. 2. Department of Abdominal, Thoracic Surgery and Traumatology, 1st Medical School, Charles University, Prague, Czech Republic. 3. Royal Derby Hospital, Uttoxeter Road, Derby, DE22 3NE, UK. klezl.zdenek.sen@seznam.cz. 4. Department of Orthopaedics and Traumatology, 3rd Medical School, Charles University, Prague, Czech Republic. klezl.zdenek.sen@seznam.cz.
Abstract
INTRODUCTION: Cervical spondylotic myelopathy (CSM) can lead to significant disability through a spectrum of clinical manifestations ranging from dexterity loss to more profound weakness, incontinence and paralysis. AIM: To determine the outcome of surgical decompression for CSM and investigate pre-operative predictors of outcome. METHODS: Prospectively collected data on all patients who underwent decompressive surgery for CSM and completed 12-month follow-up were reviewed. Data on age, MRI T1 and T2 signal changes pre-operatively, surgical approach and the Nurick's Myelopathy Grade (NMG) was analysed pre-operatively and 1 year post-surgery. RESULTS: Data on 93 consecutive patients who underwent surgery for CSM were reviewed. Median age was 62 (23-94) years and 59% were male. The median follow-up was 37 (17-88) months. The approach was anterior in 38 (42%) patients, posterior in 55 (58%); improvement was not significantly different when the two groups were compared. The number of levels decompressed increased with age (p value <0.0001). The group with a pre-operatively high signal on T1-weighted MRI images [n = 28 (30%)] was associated with less neurological recovery post-operatively compared to the patients with a normal T1 cord signal. None of the patients deteriorated neurologically post-operatively, while 66% improved by at least one NMG. CONCLUSION: Surgical decompressions for CSM stop the progress of symptoms at 12 months post-surgery and may result in a significant improvement of NMG in two-thirds of the patients. Changes in the T1-weighted MRI images predict worse outcomes following surgery.
INTRODUCTION: Cervical spondylotic myelopathy (CSM) can lead to significant disability through a spectrum of clinical manifestations ranging from dexterity loss to more profound weakness, incontinence and paralysis. AIM: To determine the outcome of surgical decompression for CSM and investigate pre-operative predictors of outcome. METHODS: Prospectively collected data on all patients who underwent decompressive surgery for CSM and completed 12-month follow-up were reviewed. Data on age, MRI T1 and T2 signal changes pre-operatively, surgical approach and the Nurick's Myelopathy Grade (NMG) was analysed pre-operatively and 1 year post-surgery. RESULTS: Data on 93 consecutive patients who underwent surgery for CSM were reviewed. Median age was 62 (23-94) years and 59% were male. The median follow-up was 37 (17-88) months. The approach was anterior in 38 (42%) patients, posterior in 55 (58%); improvement was not significantly different when the two groups were compared. The number of levels decompressed increased with age (p value <0.0001). The group with a pre-operatively high signal on T1-weighted MRI images [n = 28 (30%)] was associated with less neurological recovery post-operatively compared to the patients with a normal T1 cord signal. None of the patients deteriorated neurologically post-operatively, while 66% improved by at least one NMG. CONCLUSION: Surgical decompressions for CSM stop the progress of symptoms at 12 months post-surgery and may result in a significant improvement of NMG in two-thirds of the patients. Changes in the T1-weighted MRI images predict worse outcomes following surgery.
Authors: Julio C Furlan; Sukhvinder Kalsi-Ryan; Ahilan Kailaya-Vasan; Eric M Massicotte; Michael G Fehlings Journal: J Neurosurg Spine Date: 2011-01-14
Authors: Spyridon K Karadimas; W Mark Erwin; Claire G Ely; Joseph R Dettori; Michael G Fehlings Journal: Spine (Phila Pa 1976) Date: 2013-10-15 Impact factor: 3.468
Authors: Allan R Martin; Lindsay Tetreault; Aria Nouri; Armin Curt; Patrick Freund; Vafa Rahimi-Movaghar; Jefferson R Wilson; Michael G Fehlings; Brian K Kwon; James S Harrop; Benjamin M Davies; Mark R N Kotter; James D Guest; Bizhan Aarabi; Shekar N Kurpad Journal: Global Spine J Date: 2021-11-19