133. NEUROLOGICAL RECOVERY IN OPERATED CERVICAL MYELOPATHY

Abstract

Purpose of the study: Progressive cervical myelopathy secondary to cervical stenosis is generally treated surgically. Results of surgical decompression are generally good, but the progression and the type of neurological recovery have not been studied. We followed a cohort of patients who underwent cervical decompression in order to study the kinetics and the mode of the neurological recovery after surgery.

Material and methods: This was a prospective mono-centric observation study conducted in a routine clinical setting. The cohort included 60 patients (mean age 65.7 years) who underwent surgery around 2006. Inclusion criteria were an association of stenosis documented on the imaging and clinical signs of medullary compression. One surgeon performed all interventions (80% posterior approach, 15% anterior and 5% mixed). Preoperative evaluation used complete cervical imaging and three validated function tests: the global JOA score, the Crockard walking test, and the nine-hold plug test of manual dexterity (9HPT) for both hands. Patients were reviewed postoperatively at 1, 3, 6, 12, 18 and 24 months. Two populations were distinguished: group 1 with mild to moderate compression: mean preoperative JOA > 10; group 2 with severe compression: mean pre-operative JOA ≤10.

Results: The mean preoperative JOA was 11.7/17 (5; 15), the mean Crockard 34.5s (24; 140), and the mean time for the 9HPT 23s for both hands. Analysed by group according to the JOA showed that cervical myelopathy is mainly expressed by sensorial disorders. The JOA score, the walking test and the hand dexterity test for the dominant hand described the same pattern of recovery with a clear improvement for the first three postoperative months then a neurological stabilisation of the acquired improvement on a plateau that persisted till the end of follow-up. There was no improvement in the non-dominant hand. The same pattern was observed in both groups: the severe group presented a better improvement, reaching a final JOA score equivalent to that in the “mild-to-moderate” group.

Discussion: The pattern of recovery of cervical neurological deficits occurs rapidly during the first three months following surgical decompression, then stabilises on a plateau, irrespective of the severity of the initial condition. The benefit is certain for initially severe compression.