Outcome of operative management of degenerative compressive myelopathy of cervical spine

Author(s): Dr. Anshul Gupta, Dr. Shahrukhkhan Pathan, Dr. Jitender Singh and Dr. Ankur Mali

Abstract: Cervical spondylotic myelopathy is a serious complication of cervical spondylosis. Surgery is increasingly recommended as the preferred treatment strategy for patients with CSM as it can effectively halt disease progression and improve neurological outcomes. Aims of the study were to determine functional outcomes, perioperative complications and to compare for safety and efficacy of different surgical treatments available for CSM. Prospective case series included all consecutive patients with CSM who underwent cervical decompressive surgery from August 2015 to March 2017 at the Orthopaedic Department, New Civil Hospital, Surat. Functional disability was assessed on the basis of the mJOA score, European Myelopathy Score and Nurick’s grading. 3 Women and 17 men with ages ranging from 37 to 65 years underwent surgical spinal cord decompression. Discectomy with anterior fusion (n = 7), corpectomy with anterior fusion (n = 2), decompressive laminectomy (n= 3), laminectomy with lateral mass fixation (n = 2) and laminoplasty (n = 6) were the operative procedures in study. Preoperative functional scorings of the patients were mJOA (12.20±2.76), EMS (11.70±3.10) and Nurick’s grade (3.15±1.3) There was a statistically significant improvement in mean scores at 6 months in The Nurick’s grades (2.0±1.21) (p <0.0015), mJOA (14.85±2.35) (p < 0.0009), EMS (15.35±2.3) (p < 0.0001). Complications like chronic cervical pain (axial or radicular) and C5 radiculopathy occurred in 3 patients operated anteriorly. Intraoperative excessive bleeding occurred in 3 patients operated posteriorly required packing with hemostatic agent. While comparing the functional outcome for anterior and posterior procedures using 6month, 1 year and 2 year postoperative mJOA score and European myelopathy score, result is significantly better for posterior procedures (p values <0.05). Surgery for CSM is associated with significant functional recovery. Posterior decompression shows significantly better results but more postoperative complication than anterior decompression.

DOI: https://doi.org/10.22271/ortho.2019.v5.i2p.1475