Surgical Treatment Of Cervical Spondylotic Myelopathy Research Articles

Impact of Preoperative Frailty on Outcomes in Patients with Cervical Spondylotic Myelopathy Undergoing Anterior vs. Posterior Cervical Surgery.

Introduction: Frailty has been shown to negatively influence patient outcomes across many disease processes, including in the cervical spondylotic myelopathy (CSM) population. The aim of this study was to assess the impact that frailty has on patients with CSM who undergo anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF). Materials and Methods: A retrospective cohort study was performed using the 2016-2019 national inpatient sample. Adult patients (≥18 years old) undergoing ACDF only or PCDF only for CSM were identified using ICD codes. The patients were categorized based on receipt of ACDF or PCDF and pre-operative frailty status using the 11-item modified frailty index (mFI-11): pre-Frail (mFI = 1), frail (mFI = 2), or severely frail (mFI ≥ 3). Patient demographics, comorbidities, operative characteristics, perioperative adverse events (AEs), and healthcare resource utilization were assessed. Multivariate logistic regression analyses were used to identify independent predictors of extended length of stay (LOS) and non-routine discharge (NRD). Results: A total of 37,990 patients were identified, of which 16,665 (43.9%) were in the pre-frail cohort, 12,985 (34.2%) were in the frail cohort, and 8340 (22.0%) were in the severely frail cohort. The prevalence of many comorbidities varied significantly between frailty cohorts. Across all three frailty cohorts, the incidence of AEs was greater in patients who underwent PCDF, with dysphagia being significantly more common in patients who underwent ACDF. Additionally, the rate of adverse events significantly increased between ACDF and PCDF with respect to increasing frailty (p < 0.001). Regarding healthcare resource utilization, LOS and rate of NRD were significantly greater in patients who underwent PCDF in all three frailty cohorts, with these metrics increasing with frailty in both ACDF and PCDF cohorts (LOS: p < 0.001); NRD: p < 0.001). On a multivariate analysis of patients who underwent ACDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.39, p < 0.001; (severely frail) OR: 2.25, p < 0.001] and NRD [(frail) OR: 1.49, p < 0.001; (severely frail) OR: 2.22, p < 0.001]. Similarly, in patients who underwent PCDF, frailty and severe frailty were found to be independent predictors of extended LOS [(frail) OR: 1.58, p < 0.001; (severely frail) OR: 2.45, p < 0.001] and NRD [(frail) OR: 1.55, p < 0.001; (severely frail) OR: 1.63, p < 0.001]. Conclusions: Our study suggests that preoperative frailty may impact outcomes after surgical treatment for CSM, with more frail patients having greater health care utilization and a higher rate of adverse events. The patients undergoing PCDF ensued increased health care utilization, compared to ACDF, whereas severely frail patients undergoing PCDF tended to have the longest length of stay and highest rate of non-routine discharge. Additional prospective studies are necessary to directly compare ACDF and PCDF in frail patients with CSM.

Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

Background/Aim. Treatment options for cervical spondylotic myelopathy (CSM) are the topic for discussion due to the lack of controlled randomized prospective studies. Also, the natural history of CSM is unpredictable and the efficacy of surgical decompression is still controversial. The aim of this prospective study was to describe the results of surgical treatment of patients with CSM in a single institution. Methods. Fifty-nine patients with symptomatic CSM were enrolled in this single-center prospective study. At the end of the follow-up period of 12 months, 50 patients were analyzed. All patients were operated on; surgical decompression was performed by anterior or posterior surgical approach. Outcome evaluations were obtained preoperatively and 12 months postoperatively by using the following outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick score and the Neck Disability Index (NDI). The functional recovery ratio was calculated postoperatively by using Hirabayashi?s formula. Results. According to our results, significant improvements were detected in all outcome variables (mJOA score, Nurick score and NDI). Also, a statistically significant improvement was observed in all three categories of patients according to the preoperative mJOA score (mild, moderate, severe). Twenty-three patients (46%) had a satisfactory functional recovery, while twenty-seven (54%) had an unsatisfactory functional recovery rate. Conclusion. Surgical treatment of CSM is a very effective treating method and it resulted in a significant improvement in all outcome measures for a 1-year follow-up period. New studies could be recommended to evaluate the course of the disease, define the optimal surgical strategy, and better determine surgical outcome predictors.

Adjacent two-level anterior cervical discectomy and fusion versus one-level corpectomy and fusion in cervical spondylotic myelopathy: Analysis of perioperative parameters and sagittal balance

ObjectivesThe optimal surgical strategy for cervical spondylotic myelopathy (CSM) remains controversial; thus, the current study was designed to compare the outcomes of two different anterior approach surgeries for two-level CSM, namely, adjacent two-level anterior cervical discectomy and fusion (ACDF) and one-level anterior cervical corpectomy and fusion (ACCF). Patients and methodsA total of 53 patients who underwent adjacent two-level ACDF and 68 patients who underwent one-level ACCF in the Spinal Surgery Department from January 2010 to October 2017 were retrospectively analyzed. Independent sample t tests and chi-square tests were used to compare perioperative parameters (hospital stays, bleeding amounts and operation times), clinical parameters (Neck Disability Index scores and Visual Analog Scale scores for neck and arm pain), and radiologic parameters (difference in segmental height, T1 slope, C2-7 sagittal vertical axis, C2-7 lordosis, segmental angle, and fusion rate). ResultsThe length of hospital stay (p < 0.01), bleeding amount (p < 0.01), operation time (p < 0.001) and difference in segmental height (p < 0.001) were significantly greater in the ACCF group than in the ACDF group, whereas C2-7 lordosis (p < 0.05) and the segmental angle (p < 0.001) were significantly lower in the ACCF group than in the ACDF group. Other parameters were not significantly different between the two groups. ConclusionBoth ACDF and ACCF provided satisfactory clinical outcomes and fusion rates for CSM. However, adjacent two-level ACDF was associated with shorter hospital stays, less blood loss, shorter operative times, fewer differences in segmental height and greater improvement in segmental lordotic curvature. On most occasions, when either surgical method could be selected, adjacent two-level ACDF as a surgical treatment for CSM may be a worthwhile alternative method to one-level ACCF.

Complication and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in Medicare Beneficiaries.

Retrospective database review. To compare complication and reoperation rates after anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCFs), and anterior cervical corpectomy and fusion (ACCF) for cervical spondylotic myelopathy (CSM) using a large national database of Medicare beneficiaries. CSM is the most common cause of myelopathy in patients over 55 years and is considered the most common cause of spinal cord dysfunction in the world. Surgical treatment includes ACDF, PCF, or ACCF procedures. The PearlDiver database (2005-2012) was utilized to determine revision rates after surgical treatment of CSM by one of the aforementioned surgical treatments. Specifically, 1 to 2 level ACDF, ACCF, and PCF and 3+ level PCF cohorts were included. Each cohort was stratified by the age of 65 years. Survivorship curves were graphed and compared. Of the patients younger than 65 years of age, there were 10,557 patients treated with 1 to 2 level ACDF procedures, 1319 patients with 1 to 2 level PCF procedures, 1203 patients with 1 to 2 level ACCF procedures, and 2312 patients treated with 3+ level PCF procedures. Of the elderly patients, 24,310 patients were treated with 1 to 2 level ACDFs, 4776 with 1 to 2 level PCF procedures, 3109 with 1 to 2 level ACCFs, and 7760 with 3+ level PCFs. Patients younger than 65 years of age were significantly more likely to have a reoperation procedure, than those 65 years or older when analyzing ACCF, ACDF, and 3+ level PCF procedures. ACCFs were significantly more likely than ACDFs to require reoperation. Patients treated with PCF were consistently more likely to have nondysphagia-related complications than those treated with ACDF. Rates of transfusion, dysphagia, and hematoma/seroma formation were significantly increased with ACCF compared with ACDF within the elderly population. The elderly are significantly less likely to have a revision surgery after surgical treatment for CSM. Patients treated with ACCF are more likely to need a revision than those treated with ACDF. 3.

Cervical Spondylotic Myelopathy: Pathophysiology and Surgical Approaches

This paper reviews the pathophysiology of cervical spondylotic myelopathy (CSM) and several surgical approaches for the treatment of CSM. CSM is a degenerative disease with severe morbidity. The pathophysiology of CSM involves static, dynamic, and ischemic factors. The management of mild CSM typically involves conservative treatments and medication; whereas, moderate and severe CSM are better treated surgically. Surgical treatments for CSM are basically classified into anterior and posterior surgeries. The common techniques are anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), laminectomy, and laminoplasty. Each technique has its own advantages and disadvantages. In this paper, we review the research papers from PubMed database to elaborate the advantages and disadvantages of each technique.

Diabetes as an Independent Predictor for Extended Length of Hospital Stay and Increased Adverse Post-Operative Events in Patients Treated Surgically for Cervical Spondylotic Myelopathy.

Diabetes as an independent driver of peri-operative outcomes, and whether its severity impacts indications is conflicted in the research. The purpose of this study is to evaluate diabetes as a predictor for postoperative outcomes in cervical spondylotic myelopathy (CSM) patients. A retrospective review was performed of patients treated surgically for CSM (ICD-9 721.1) from 2010-2012 in the prospectively-collected American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Outcome measures were length of stay, and the presence of complications. Diabetic patients were stratified based on whether or not their diabetes was insulin- or non-insulin-dependent. A total of 5,904 surgical CSM patients were included, 1101 (19%) had diabetes. 722 (65%) were non-insulin-dependent diabetics, and 381 (35%) were insulin-dependent diabetics. Diabetes was found to be an independent predictor of extended LOS (OR: 1.878[2.262-1.559], p<0.001) as well as of developing a complication (OR: 1.666[2.217-1.253], p<0.001) after controlling for associated variables like BMI. Type of diabetes (insulin- vs. non-insulin-dependent) showed little significant difference between the groups (p>0.05), however, patients with insulin-dependent diabetes were associated with an increased incidence of wound complications (p=0.027); severity of diabetes was not associated with any other individual complications. Type and severity of diabetes is not a predictor for complication. Diabetes is associated with extended LOS and peri-operative morbidity. Level of evidence: Class 2b. Clinical relevance: Our findings support the view of many spine surgeons, who believe that diabetes has a negative impact on the outcome of surgery for CSM. Our findings support those cohort studies that found an association between diabetes and worst post-operative outcomes following surgical treatment of CSM. These findings lend support to the importance of monitoring preoperative serum glucose levels, as prevention of peri-operative hyperglycemia has been linked to improved postoperative outcomes in spine, joint and colon surgery.

Surgical outcomes of cervical spondylotic myelopathy: an analysis of a national, administrative, longitudinal database.

OBJECTIVE The authors performed a population-based analysis of national trends, costs, and outcomes associated with cervical spondylotic myelopathy (CSM) in the United States. They assessed postoperative complications, resource utilization, and predictors of costs, in this surgically treated CSM population. METHODS MarketScan data (2006-2010) were used to retrospectively analyze the complications and costs of different spine surgeries for CSM. The authors determined outcomes following anterior cervical discectomy and fusion (ACDF), posterior fusion, combined anterior/posterior fusion, and laminoplasty procedures. RESULTS The authors identified 35,962 CSM patients, comprising 5154 elderly (age ≥ 65 years) patients (mean 72.2 years, 54.9% male) and 30,808 nonelderly patients (mean 51.1 years, 49.3% male). They found an overall complication rate of 15.6% after ACDF, 29.2% after posterior fusion, 41.1% after combined anterior and posterior fusion, and 22.4% after laminoplasty. Following ACDF and posterior fusion, a significantly higher risk of complication was seen in the elderly compared with the nonelderly (reference group). The fusion level and comorbidity-adjusted ORs with 95% CIs for these groups were 1.54 (1.40-1.68) and 1.25 (1.06-1.46), respectively. In contrast, the elderly population had lower 30-day readmission rates in all 4 surgical cohorts (ACDF, 2.6%; posterior fusion, 5.3%; anterior/posterior fusion, 3.4%; and laminoplasty, 3.6%). The fusion level and comorbidity-adjusted odds ratios for 30-day readmissions for ACDF, posterior fusion, combined anterior and posterior fusion, and laminoplasty were 0.54 (0.44-0.68), 0.32 (0.24-0.44), 0.17 (0.08-0.38), and 0.39 (0.18-0.85), respectively. CONCLUSIONS The authors' analysis of the MarketScan database suggests a higher complication rate in the surgical treatment of CSM than previous national estimates. They found that elderly age (≥ 65 years) significantly increased complication risk following ACDF and posterior fusion. Elderly patients were less likely to experience a readmission within 30 days of surgery. Postoperative complication occurrence, and 30-day readmission were significant drivers of total cost within 90 days of the index surgical procedure.

The Change of Range of Motion at Anterior Compression of the Cervical Cord after Laminoplasty in Patients with Cervical Spondylotic Myelopathy.

ObjectiveDegenerative diseases of the spine, such as cervical spondylotic myelopathy (CSM), are increasing among the old age population, and surgical treatment of CSM is becoming more and more common. The aim of this study was to investigate how functional recovery can be influenced by anterior compression of the spinal cord (ACS) after laminoplasty for treatment of patients with CSM.MethodsWe retrospectively analyzed 32 patients admitted to Ewha Womans Mok-Dong Hospital with CSM who underwent open-door laminoplasty from January 2012 to December 2014. We divided patients into 2 groups according to whether ACS was or not preoperatively. Each group was analyzed clinical and radiological parameters which were Japanese Orthopedic Association (JOA) scores and its recovery rate, sagittal alignment and range of motion (ROM).ResultsThe mean duration of symptom was 11.2 months (range, 6-22 months). A significant difference in recovery rate of the total JOA score was shown between the 2 groups, especially upper extremity motor function. No difference in preoperative JOA score between the 2 groups, but recovery rate of each group was 20.05%±18.1%, 32.21%±25.4%, statistically significant (p<0.005). Upper motor and sensory function was not significantly different in the 2 groups. Preoperative, postoperative and preservation of ROM was 44.3°±10.1°, 41.8°±15.7°, 87.9%±35.4% each at ACS (-) group. A significant difference in postoperative ROM was identified between ACS (-) and ACS (+) group. Postoperative anterior compression of the spinal cord was recognized 14 cases which were classified from its causes.Conclusion Cervical ROM decreased significantly after laminoplasty, but 85.3% of the preoperative ROM was preserved. The postoperative reduction of ROM in group with anterior compression of spinal cord was identified.

A Comparison between Anterior and Posterior Surgical Approaches in the Treatment of Cervical Spondylotic Myelopathy

Introduction Cervical spondylotic myelopathy (CSM) is a common problem in our aging population. We aim to compare the efficacy and safety of anterior and posterior approaches in the surgical treatment of CSM using validated outcome measures in a prospective cohort study. Materials and Methods Patients with defined clinical features of CSM were recruited from three hospitals in Singapore between October 2009 and December 2010. A total of 17 participants were recruited, and baseline demographic variables and outcome measure scores were established. Namely, the modified Japanese Orthopaedic Association (mJOA) score, Nurick, Short Form-36 (SF-36) Health Survey Questionnaire score, and Neck Disability Index (NDI). Participants underwent decompressive surgery by anterior or posterior approach, with choice of technique left to surgeon preference. Scores were retaken at 6, 12, and 24 months after surgery for comparison against baseline, within and between groups through the follow-up period. Results Patients who underwent anterior approach surgery were younger, had fewer comorbidities, less extensive disease, better SF-36 physical functioning, and mJOA scores at baseline. Both groups had clinically significant improvement in scores based on validated minimum clinically important difference (MCID) values at the end of the 2-year follow-up period. Score improvement was more sustained in the anterior group, whereas in the posterior group improvement in scores was greatest at 6 months post-decompression, but declined thereafter (albeit to values still three times that at baseline). A patient who underwent posterior approach surgery developed anemia secondary to perioperative blood loss. There were no cases of implant-related complications or cases of revision surgery. Conclusion This study highlights the differences in patient and disease factors influencing choice of surgical approach and shows the safety and efficacy of CSM surgery regardless of approach.

Delayed diagnosis of cervical spondylotic myelopathy by primary care physicians

A retrospective study analyzing medical files of patients who had undergone surgical management for cervical spondylotic myelopathy (CSM) at a single tertiary hospital was performed to determine the time needed by community care physicians to reach a diagnosis of CSM in patients presenting with typical myelopathic signs and symptoms, and to establish the reasons for the delayed diagnosis when present. Previous studies have documented that early diagnosis and surgical treatment of CSM may improve patients' neurological as well as general outcome. However, patients complaining of symptoms compatible with CSM may undergo lengthy medical investigations and treatments by community-based physicians before a correct diagnosis is made. The authors have found no published data on the process and time frame involved in attaining a diagnosis of CSM in the community setting. The medical records of 42 patients were retrospectively reviewed for demographic data, symptoms, time to diagnosis, physician specialty, number of visits involved in the diagnostic process, and neurological status prior to surgery. The mean time delay from initiation of symptoms to diagnosis of CSM was 2.2 ± 2.3 years. The majority of symptomatic patients (90.4%) initially presented to a family practitioner (69%) or an orthopedic surgeon (21.4%), with fewer patients (9.6%) referring to other disciplines (for example, the emergency department) for initial care. In contrast, the diagnosis of CSM was most often made by neurosurgeons (38.1%) and neurologists (28.6%), and less frequently by orthopedic surgeons (19%) or family physicians (4.8%). The diagnosis of CSM in the community is frequently delayed, leading to late referral for surgery. A higher index of suspicion for this debilitating entity is required from family practitioners and community-based orthopedic surgeons to prevent neurological sequelae.

International Variations in the Clinical Presentation and Management of Cervical Spondylotic Myelopathy

INTRODUCTION: : While cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord impairment worldwide, little is known regarding international variations in clinical presentation, management and outcomes of this condition. To address this key issue, we undertook a prospective multicenter study of CSM patients undergoing surgical treatment. METHODS: : 486 patients with clinically symptomatic CSM were enrolled in 16 sites in Europe, Asia, North and South America. The following outcomes were assessed: modified Japanese Orthopaedic Assessment scale (mJOA), Nurick Score, Neck Disability Index (NDI), short form 36v2, and complications. Data were analyzed using multivariate techniques (SAS 9.2) adjusting for baseline differences in patient populations (age, gender, surgical approach, number of spinal levels and baseline outcome parameter value). RESULTS: : To date, 389 patients have completed the 1-year follow-up. Thirty-five percent were females with an average age of 56.2 yrs (SD 12.4). Patients underwent anterior (58%), posterior (40%) or circumferential (2%) surgery. There were significant differences in the age at presentation and baseline neurological status among the regions, with Asian and Latin American patients being significantly younger and with less neurological impairment. With surgical treatment, there was a significant (P < 0.001) improvement from baseline values to 12 months in all outcome parameters assessed. The amount of improvement varied across the international regions with patients from Asia-Pacific and Latin America reporting comparatively better SF36 PCS and MCS scores for comparatively similar outcomes on the Nurick and mJOA assessments. CONCLUSION: : This large prospective global clinical study shows that surgical treatment for CSM is associated with significant improvements in generic and patient-specific outcome measures at one-year. Interestingly, there are significant variations in clinical presentation and in patient perceptions of the impact of these improvements on their perceptions of quality of life.

Degenerative spondylolisthesis does not influence surgical results of laminoplasty in elderly cervical spondylotic myelopathy patients

The objective of the study was to investigate the comorbidity of degenerative spondylolisthesis (DS), in elderly cervical spondylotic myelopathy (CSM) patients in our hospital, and the correlation between surgical results and preoperative DS. There are few studies on the outcome of laminoplasty for CSM with DS. A total of 49 elderly patients (>65 years old) who eventually had surgical treatment for CSM were evaluated. A slippage displacement of more than 2.5 mm at least at one level was classified to have a positive DS on flexion/extension radiographs (DS group). A slippage displacement less than 1.0 mm was considered a negative DS (non-DS group). Seventeen patients who had slippage of 1.0-2.5 mm were excluded from the study. The DS group (n = 15) included cases with DS at preoperation, while the remaining cases (n = 17) belonged to the non-DS group. The flexion/extension radiographs of the two groups were compared for range of motion and clinical results at 3 years after the operation. Of all elderly patients, 30.6% had DS. There was no significant difference between the two groups based on the clinical results. The range of motion of all cervical spines (DS group and non-DS group) was significantly limited. However, there was no significant difference between the two groups. New postoperative DS appeared in four patients, of which two were from the DS group and two from the non-DS group. These data suggest that degenerative spondylolisthesis does not influence surgical results in elderly cervical spondylotic myelopathy patients.

Cervical surgical techniques for the treatment of cervical spondylotic myelopathy

The objective of this systematic review was to use evidence-based medicine to compare the efficacy of different surgical techniques for the treatment of cervical spondylotic myelopathy (CSM). The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to anterior and posterior cervical spine surgery and CSM. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. A variety of techniques have improved functional outcome after surgical treatment for CSM, including anterior cervical discectomy with fusion (ACDF), anterior cervical corpectomy with fusion (ACCF), laminoplasty, laminectomy, and laminectomy with fusion (Class III). Anterior cervical discectomy with fusion and ACCF appear to yield similar results in multilevel spine decompression for lesions at the disc level. The use of anterior plating allows for equivalent fusion rates between these techniques (Class III). If anterior fixation is not used, ACCF may provide a higher fusion rate than multilevel ACDF but also a higher graft failure rate than multilevel ACDF (Class III). Anterior cervical discectomy with fusion, ACCF, laminectomy, laminoplasty, and laminectomy with arthrodesis all provide near-term functional improvement for CSM. However, laminectomy is associated with late deterioration compared with the other types of anterior and posterior surgeries (Class III). Multiple approaches exist with similar near-term improvements; however, laminectomy appears to have a late deterioration rate that may need to be considered when appropriate.

Does developmental canal stenosis influence surgical results of bilateral open-door laminoplasty for cervical spondylotic myelopathy?

The purpose of this study was to investigate the prevalence of developmental canal stenosis in patients with cervical spondylotic myelopathy (CSM), and the correlation between surgical results and degree of developmental canal stenosis. A total of 112 patients who eventually had surgical treatment for CSM were evaluated. Male patients whose sagittal spinal diameter was < 14 mm and females whose sagittal diameter was < 13 mm even at one level were classified as having developmental canal stenosis. Two groups of patients were used in this study; the "positive" group (57 cases) included patients with developmental canal stenosis preoperatively, whereas the "negative" group (55 cases) excluded such patients. Lateral functional radiographs obtained in patients in the 2 groups were compared for range of motion and clinical results. Developmental canal stenosis was found in 50.9% of all cases. Based on clinical results, there was no significant difference between the 2 groups. Patients with CSM showed a high incidence of preoperative developmental canal stenosis. However, there were no significant differences in clinical results between patients with and without this disorder. These results indicate that developmental canal stenosis is not a factor that influences surgical results.

Anterolisthesis and retrolisthesis of the cervical spine in cervical spondylotic myelopathy in the elderly

BackgroundDegenerative spondylolisthesis of the cervical spine has received insufficient attention in contrast to that of the lumbar spine. The authors analyzed the functional significance of anterior and posterior degenerative spondylolisthesis (anterolisthesis and retrolisthesis) of the cervical spine to elucidate its role in the development of cervical spondylotic myelopathy (CSM) in the elderly. MethodsA total of 79 patients aged 65 or older who eventually had surgical treatment for CSM were evaluated radiographically. ResultsAltogether, 24 patients (30%) had displacement of 3.5mm or more (severe spondylolisthesis group), 31 had displacement of 2.0–3.4mm (moderate spondylolisthesis group), and 24 had less than 2.0mm displacement (mild spondylolisthesis group). The severe spondylolisthesis group consisted of 14 patients with anterolisthesis (anterolisthesis group) and 10 patients with retrolisthesis (retrolisthesis group). Patients with severe spondylolisthesis had a high incidence (93%) of degenerative spondylolisthesis at C3/4 or C4/5 and significantly greater cervical mobility than those with mild spondylolisthesis. The anterolisthesis group, but not the retrolisthesis group, had a significantly wider spinal canal than the mild spondylo-listhesis group, although the degree of horizontal displacement and cervical mobility did not differ significantly between the anterolisthesis and retrolisthesis groups. Severe cord compression seen on T1-weighted magnetic resonance imaging (MRI) scans and high-intensity spinal cord signals seen on T2-weighted MRI scans corresponded significantly to the levels of the spondylolisthesis. ConclusionsDegenerative spondylolisthesis is not a rare radiographic finding in elderly patients with CSM, which tends to cause intense cord compression that is seen on MRI scans. Greater mobility of the upper cervical segments may be a compensatory reaction for advanced disc degeneration of the lower cervical segments, leading to the development of degenerative spondylolisthesis. With a similar degree of displacement, anterolisthesis tends to have a greater impact on the development of CSM than retrolisthesis.

Measurement of outcome in patients with cervical spondylotic myelopathy treated surgically

The objective was to establish the role of the Short Form 36 (SF 36) as an objective measure of clinical outcome in cervical spondylotic myelopathy (CSM), and took the form of a prospective observational study. Seventy patients with symptomatic CSM were treated by surgical decompression. Health status was measured pre- and 3 months postoperation using objective, validated patient completed measures. These were the SF 36, neck disability index, myelopathy disability index and analogue scores for neck pain and arm symptoms. SF 36 scores were compared with age matched control data. Twelve-month postoperative data are available in a proportion of the cohort. CSM patients have lower preoperative SF 36 scores than age-matched population controls. Comparing pre- and postoperative SF36 scores for the physical functioning domain 64% of patients improve, 23% show no change and 14% of patients continue to deteriorate (Wilcoxon P< 0.0001). These changes are replicated in other domains of the SF36 and by the other measures of outcome. The SF36 is responsive, valid, and practical. Its use for determining outcome in the surgical treatment of CSM is recommended.

Measurement of outcome in patients with cervical spondylotic myelopathy treated surgically

The objective was to establish the role of the Short Form 36 (SF 36) as an objective measure of clinical outcome in cervical spondylotic myelopathy (CSM), and took the form of a prospective observational study. Seventy patients with symptomatic CSM were treated by surgical decompression. Health status was measured pre- and 3 months postoperation using objective, validated patient completed measures. These were the SF 36, neck disability index, myelopathy disability index and analogue scores for neck pain and arm symptoms. SF 36 scores were compared with age matched control data. Twelve-month postoperative data are available in a proportion of the cohort. CSM patients have lower preoperative SF 36 scores than age-matched population controls. Comparing pre- and postoperative SF36 scores for the physical functioning domain 64% of patients improve, 23% show no change and 14% of patients continue to deteriorate (Wilcoxon P< 0.0001). These changes are replicated in other domains of the SF36 and by the other measures of outcome. The SF36 is responsive, valid, and practical. Its use for determining outcome in the surgical treatment of CSM is recommended.