Prospective study of surgical outcomes of cervical myelopathy based on its etiology, duration of affection and radiological patterns of compression

Abstract

<p><strong>Background: </strong>Cervical spondylotic myelopathy (CSM) is considered the commonest cause of spinal cord dysfunction in individuals above 55 years of age and if left untreated, permanent cord damage may occur. This could contribute to increased dependence and reduced quality of life in older individuals. A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria.<strong></strong></p><p><strong>Methods</strong>: A prospective cohort study done in patients with cervical myelopathy who were admitted and operated after considering inclusion and exclusion criteria. Total 30 patients included in study. patients were operated according to patterns of compression. Anterior/posterior decompression SOS instrumentation was done according to POC. Pre-op and post-op Nurick’s grading, pre-op and post-op modified Japanese orthopaedics association (mJOA) scores were used for comparison. Patients were followed up for period of 1 year from surgical intervention. Recovery rate calculated using preop and post op mJOA scores.</p><p><strong>Results</strong>: Overall satisfactory surgical outcome found in patients of cervical myelopathy<sub>, </sub>out of 30 patients, 9 patients of pattern of compression I (POC I) had recovery rate (RR) of (91.6±7.8) , 8 patients of POC II had RR of (78.4±14.8), 6 patients of POC III had RR of (73.5±11.1), 4 patients of POC IV had RR of (74.9±29.2), 3 patients of POC IVv had RR of (80.4±4.1).the assessment of the final outcome was done using mJOA scoring system and Nurick’s grading system.</p><p><strong>Conclusions: </strong>Anterior cervical discectomy and fusion (ACDF) for POC I (one- or two-level anterior cord compression) and POC II (one or two levels of anterior and posterior cord compression) give good surgical outcome. Cervical laminectomy and SOS instrumentation is recommended for POC III (3 levels of anterior cord compression), IV (3 or more levels of anterior compression and development of narrow canal with multiple posterior compression) and IV variant (similar to POC IV with one or two levels, being more significant than the others).earlier diagnosis, prompt radiological investigations, individualizing surgical protocol, proper surgical techniques and proper follow-up evaluation are key in management of patients of cervical myelopathy.</p>