Cervical spondyloticmyelopathy: the pattern of neurologic deficits and improvement following anterior cervical decompression

ABSTRACT

We evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy [CSM] to determine findings which had a predictive value for surgical outcome. Consecutive patients with CSM caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in Loghman Hakim Hospital from 1999-2003 were prospectively enrolled. Patients were evaluated postoperatively by office visit. Outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. Forty - three patients [30 male, 13 female] with a mean age of 48.8 years fulfilled our inclusion criteria. The most common preoperative symptoms were sensory deficit in distal upper limbs [88.4%], gait disturbance [69.8%] and sensory deficit of distal lower limbs [58.1%]. The most common signs were hyperreflexia [95.3%], Hoffman's sign [93%] and Babinski's sign [83.7%]. Vertebral osteophyte and soft disc herniation were found in 86% and 14% of the patients, respectively. Overall functional improvement, evaluated by using a modification of the Japanese Orthopedic Association Scale was noted in 79.7% of the patients who had an abnormal scale preoperatively. Strength improved considerably and significantly after operation. However, less than half of the patients experienced functional improvement in the lower limbs, a discrepancy that was probably caused by persistent spasticity. Atrophy of the hand muscles, preoperative spastic gait and cord atrophy as shown in MRI were poor prognostic factors