CERVICAL SPONDYLOTIC MIELOPATHY-MINIMAL 10 YEARS FOLLOW UP

Abstract

Cervical Spondylotic Mielopathy (CSM) is the most common cause of spinal cord dysfunction in the adult population. Treatment implies surgical decompression as soon as possible after the diagnosis. In this study the authors present the long term results of minimal 10 years follow up of a prospective study of 98 patients that underwent anterior decompression and arthrodesis surgery for CSM.

Patients that underwent surgery for CSM between January 1990 and December 1994 were evaluated for sex, age, number of levels operated, functional evaluation with Nurick Scale pre operatively, 1 year after surgery and at the final the revision that took place in 2007 and 2008, evidence of consolidation and complications. All the patients were operated by anterior approach. T-Student Test was performed with SPSS for statistical analysis.

99 patients were evaluated during the study, 73 male, 26 female, with a mean age of 56, 6 years (42–86) and mean follow up time of 14,4 years. 3 patients died in the immediate pos op period, 1 in the first year, 8 during the 15 year evaluation period. 16 patients were operated for 1 level, 22 for two levels, 36 for 3 levels and 22 for four levels (mean on 2,7±1,0 levels for patient).

Pre op Nurick was 3,8±0,9. There was a significant improvement in neurological condition after one year surgery (Nurick 2,2±1,1; p< 0,001), and between pre op and final evaluation (2,3±1,2; p< 0,001). The degradation between the first year and the final evaluation was statistically significant (p=0,004).

There was a strong correlation between age and the number of operated levels (r=0,391, p=0,01), age and initial neurologic status (r=0,238, p=0,05), initial neurological status and number of operated levels (r=0,251, p=0,05) and sex and number of operated levels, with women being operated for more levels (r=0,208, p=0,05). There was also e stronger neurological deterioration between year 1 and year 15 in young patients when compared to older ones (r=0,250, p=0,05). There is a strong clinical relation between first year recuperation and final recuperation (r=0,838, p=0,01). There was a 100% rate of consolidation.

Surgical treatment for decompression and arthrodesis is considered for us the best option for the treatment of CSM in terms of improvement of pain, alignment and neurological function. A significant neurological improvement comes from surgery, and despite a significant clinical deterioration between the first year and the final evaluation, the benefits of surgery are still evident 15 years after, with a better neurological status when compared to the pre operative period.