Abstract
PurposeDegenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery.MethodsA retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome.ResultsIn total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score.ConclusionMotor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.
Highlights
Degenerative cervical myelopathy (DCM) is an age-dependent deterioration of the spinal cord with an increasing epidemiologic relevance
Surgical treatment is recommended for severe and moderate DCM, while the treatment of mild DCM is still discussed [9]
During the postoperative follow-up, there was an improvement of the mJOA Score in that cohort, but the significant difference compared to patients without motor deficits remained (16.5 versus 17, p = 0.0005)
Summary
Degenerative cervical myelopathy (DCM) is an age-dependent deterioration of the spinal cord with an increasing epidemiologic relevance. It is the most common non-traumatic cause of spinal cord dysfunction in adults [1, 2], with a great impact on worldwide health, society and economy [3]. The degenerative process with a progressive spinal stenosis leads to an ongoing static compression of the spinal cord and the nerve roots with subsequent demyelination. This may result in necrosis of both, gray and white matter. A dynamic component resulting through the mobility of the cervical spine might increase the pressure on the spinal cord [5, 6]
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