Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

Drazen Ivetic, Goran Pavlicevic, Dejan Kostic
2019 Vojnosanitetski Pregled  
Background/Aim. Treatment options for cervical spondylotic myelopathy (CSM) are the topic for discussion due to the lack of controlled randomized prospective studies. Also, the natural history of CSM is unpredictable and the efficacy of surgical decompression is still controversial. The aim of this prospective study was to describe the results of surgical treatment of patients with CSM in a single institution. Methods. Fifty-nine patients with symptomatic CSM were enrolled in this single-center
more » ... prospective study. At the end of the follow-up period of 12 months, 50 patients were analyzed. All patients were operated on; surgical decompression was performed by anterior or posterior surgical approach. Outcome evaluations were obtained preoperatively and 12 months postoperatively by using the following outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick score and the Neck Disability Index (NDI). The functional recovery ratio was calculated postoperatively by using Hirabayashi's formula. Results. According to our results, significant improvements were detected in all outcome variables (mJOA score, Nurick score and NDI). Also, a statistically significant improvement was observed in all three categories of patients according to the preoperative mJOA score (mild, moderate, severe). Twentythree patients (46%) had a satisfactory functional recovery, while twenty-seven (54%) had an unsatisfactory functional recovery rate. Conclusion. Surgical treatment of CSM is a very effective treating method and it resulted in a significant improvement in all outcome measures for a 1-year followup period. New studies could be recommended to evaluate the course of the disease, define the optimal surgical strategy, and better determine surgical outcome predictors. Apstrakt Uvod/Cilj. Izbor tretmana u lečenju cervikalne spondilotične mijelopatije (CSM) predstavlja temu za diskusiju zbog nedostatka kontrolisanih randomizovanih prospektivnih studija. Prirodan tok CSM nije moguće predvideti, a sa druge strane efikasnost hirurške dekompresije je i dalje diskutabilna. Cilj ove prospektivne studije bio je prikazivanje rezultata hirurškog lečenja bolesnika sa CSM u jednoj hirurškoj ustanovi. Metode. U studiju je uključeno 59 bolesnika sa simptomatskom CSM u jednom centru, na kraju perioda praćenja od 12 meseci, analizirano je 50 bolesnika. Svi bolesnici u studiji su operisani, a dekompresija je urađena prednjim ili zadnjim hirurškim pristupom. Ishod je praćen preoperativno i postoperativno nakon 12 meseci pomoću skala za merenje ishoda: modifikovana skala Japanskog Udruženja Ortopeda (mJOA), Nurick-ov skor i Neck Disability Index (NDI -indeks ograničenja sposobnosti zbog bola u vratu). Funkcionalni oporavak računat je nakon operacije, korišćenjem Hirabayashijeve formule. Rezultati. Prema našim rezultatima, značajno poboljšanje je registrovano prema svim skalama za merenje ishoda (mJOA, Nurick-ov skor, NDI). Pored toga, zabeleženo je statistički značajno poboljšanje u sve tri grupe bolesnika u odnosu na preoperativni mJOA (blaga, umerena i teška mijelopatija). Funkcionalni oporavak bio je zadovoljavajući kod 23 bolesnika (46%), dok je 27 bolesnika (54%) imalo nezadovoljavajući oporavak. Zaključak. Hirurško lečenje CSM veoma je efikasna metoda lečenja, ono dovodi do značajnog poboljšanja prema svim skalama za merenje ishoda u periodu praćenja od jedne godine. Takođe, mogu se predložiti nova istarživanja radi boljeg praćenja toka bolesti, definisanja optimalne hirurške strategije i boljeg definisanja faktora koji utiču na ishod operativnog lečenja CSM.
doi:10.2298/vsp190110030i fatcat:cu6uoeymsve5ld6ajlxknbrng4