CERVICAL SPONDYLOTIC MYELOPATHY: THE PATTERN OF NEUROLOGIC DEFICITS AND IMPROVEMENT FOLLOWING ANTERIOR CERVICAL DECOMPRESSION
G.SHARIFI, M.D; B.DANESHPAJOUH, M.D; K.HADDADIAN, M.D; O.REZAEE, M.D and M.SAMADIAN, M.D
From Loghman Hakim Hospital, Shahid Beheshti University of Medicine Sciences, Tehran, Iran
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. METHOD: 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. RESULTS: 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 disk 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. CONCLUSION: Anterior cervical decompression for CSM is a promising procedure for these patients.
Keywords: Cervical Spondylosis; Myelopathy; Anterior Cervical Decompression