Prognostic Indices of Surgical Outcome in Cervical Spondylotic Myelopathy: A Clinical Prospective Study

Ahmed A. Marei; Mohamed Reda Rady; Hazem Mostafa Kamal; William C. Welch; Mohamed A. Hafez

doi:10.3889/oamjms.2021.6009

Authors

Ahmed A. Marei Department of Neurosurgery, Cairo University, Cairo, Egypt
Mohamed Reda Rady Department of Neurosurgery, Cairo University, Cairo, Egypt https://orcid.org/0000-0003-1971-6933
Hazem Mostafa Kamal Department of Neurosurgery, Cairo University, Cairo, Egypt
William C. Welch Department of Neurosurgery, Pennsylvania Hospital, Philadelphia, PA, US
Mohamed A. Hafez Department of Neurosurgery, Cairo University, Cairo, Egypt

DOI:

https://doi.org/10.3889/oamjms.2021.6009

Keywords:

Myelopathy, Prognostic factors, Cervical spondylosis, Cervical spondylotic myelopathy, Intraoperative neuro-monitoring

Abstract

BACKGROUND: One of the most common causes of spinal cord dysfunction is cervical spondylotic myelopathy (CSM) especially in the elderly. Prognostic indices can aid the surgeon preoperatively to detect the patients’ prognosis.

AIM: The aim of the work is to better assess patients and to find possible indicators for post-operative improvement or deterioration in CSM patients.

METHODS: Forty patients with multiple levels CSM, admitted and operated on in the Neurosurgery Department of Cairo University Hospitals, have been enrolled randomly in this study after fulfilling the criteria for CSM surgical intervention. The patient age, complaint duration, number of levels affected, signal intensity on T1-weighted and T2-weighted magnetic resonance (MR) images, Japan Orthopedic Association (JOA) scoring system, and Nurick’s score were evaluated before surgery and correlated with outcome after 1 year follow-up.

RESULTS: About 80% of patients improved after operation with average pre- and post-operative JOA and Nurick scores about 11.23 and 3.12; 14.1 and 1.6, respectively. Patient age, sex, number of levels affected, and signal intensity on T1- weighted and T2-weighted MR images were not significantly associated with post-operative improvement, p > 0.05. However, the only significant prognostic factor was the duration of symptoms if less than 1 year with p < 0.05.

CONCLUSION: Short complaint duration coupled with close intra-operative monitoring was directly correlated with good CMS operation outcome while age, sex, number of levels affected, presence of cord signal on MR imaging, and surgical approach appear to have no significant effect on outcome.

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Author Biographies

Mohamed Reda Rady, Department of Neurosurgery, Cairo University, Cairo, Egypt

Hazem Mostafa Kamal, Department of Neurosurgery, Cairo University, Cairo, Egypt

Professor of Neurosurgery

Faculty of Medicine, Cairo University

William C. Welch, Department of Neurosurgery, Pennsylvania Hospital, Philadelphia, PA, US

Professor of Neurosurgery

Faculty of Medicine, Pennsylvania University, USA

References

Hu P, He Z, Cui J, Wan Y. Pathological changes of cervical spinal canal in cervical spondylotic myelopathy: A retrospective study on 39 cases. Clin Neurol Neurosurg. 2019;181:133-7. https://doi.org/10.1016/j.clineuro.2019.04.016 PMid:12045513 DOI: https://doi.org/10.1016/j.clineuro.2019.04.016

Ramesh VG, Kannan MG, Sriram K, Balasubramanian C. Prognostication in cervical spondylotic myelopathy: Proposal for a new simple practical scoring system. Asian J Neurosurg. 2017;12(3):525. https://doi.org/10.4103/1793-5482.146391 PMid:28761535 DOI: https://doi.org/10.4103/1793-5482.146391

Al-Mefty O, Harkey HL, Marawi I, Haines DE, Peeler DF, Wilner HI, et al. Experimental chronic compressive cervical myelopathy. J Neurosurg. 1993;79(4):550-61. https://doi.org/10.3171/jns.1993.79.4.0550 PMid:7616281 DOI: https://doi.org/10.3171/jns.1993.79.4.0550

Kadaňka Z. Spondylotic cervical myelopathy-most frequent cause of myelopathy. Imaging studies. Eur J Neurol. 2005;12:308. DOI: https://doi.org/10.1111/j.1468-1331.2004.00896.x

Abe H. History of spinal surgery in Japan-from the pioneering period to the progressive era (1911-2017). Neurospine. 2019;16(2):155. https://doi.org/10.14245/ns.1938154.077 PMid:31261450 DOI: https://doi.org/10.14245/ns.1938154.077

Matz PG, Anderson PA, Holly LT, Groff MW, Heary RF, Kaiser MG, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine. 2009;11(2):104-11. https://doi.org/10.3171/2009.1.spine08716 PMid:19769489 DOI: https://doi.org/10.3171/2009.1.SPINE08716

Komotar RJ, Mocco J, Kaiser MG. Surgical management of cervical myelopathy: Indications and techniques for laminectomy and fusion. Spine J. 2006;6(6):S252-67. https://doi.org/10.1016/j.spinee.2006.04.029 PMid:17097545 DOI: https://doi.org/10.1016/j.spinee.2006.04.029

Heary RF, MacDowall A, Agarwal N. Cervical spondylotic myelopathy: A two decade experience. J Spinal Cord Med. 2019;42(4):407-15. https://doi.org/10.1080/10790268.2018.1471780 PMid:30048224 DOI: https://doi.org/10.1080/10790268.2018.1471780

Klineberg E. Cervical spondylotic myelopathy: A review of the evidence. Orthop Clin North Am. 2010;41(2):193-202. https://doi.org/10.1016/j.ocl.2009.12.010 PMid:20399358 DOI: https://doi.org/10.1016/j.ocl.2009.12.010

Bohannon RW, Smith MB. Assessment of strength deficits in eight paretic upper extremity muscle groups of stroke patients with hemiplegia. Phys Ther. 1987;67(4):522-5. https://doi.org/10.1093/ptj/67.4.522 PMid:3562543 DOI: https://doi.org/10.1093/ptj/67.4.522

Vitzthum HE, Dalitz K. Analysis of five specific scores for cervical spondylogenic myelopathy. Eur Spine J. 2007;16(12):2096-103. https://doi.org/10.1007/s00586-007-0512-x PMid:17922150 DOI: https://doi.org/10.1007/s00586-007-0512-x

Kopjar B, Fehlings M, Hanson B. Validity of the modified Japanese orthopedic association score in patients with cervical spondylotic myelopathy: The AOSpine North America multicenter prospective study. Spine J. 2011;11(10):S73-4. https://doi.org/10.1016/j.spinee.2011.08.183 DOI: https://doi.org/10.1016/j.spinee.2011.08.183

Zoëga B, Kärrholm J, Lind B. Outcome scores in degenerative cervical disc surgery. Eur Spine J. 2000;9(2):137-43. https://doi.org/10.1007/s005860050224 PMid:10823430 DOI: https://doi.org/10.1007/s005860050224

Lee TT, Manzano GR, Green BA. Modified open-door cervical expansive laminoplasty for spondylotic myelopathy: Operative technique, outcome, and predictors for gait improvement. J Neurosurg. 1997;86(1):64-8. https://doi.org/10.3171/jns.1997.86.1.0064 PMid:8988083 DOI: https://doi.org/10.3171/jns.1997.86.1.0064

Yagi M, Ninomiya K, Kihara M, Horiuchi Y. Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on magnetic resonance imaging. J Neurosurg Spine. 2010;12(1):59-65. https://doi.org/10.3171/2009.5.spine08940 PMid:20043766 DOI: https://doi.org/10.3171/2009.5.SPINE08940

Shin JJ, Jin BH, Kim KS, Cho YE, Cho WH. Intramedullary high signal intensity and neurological status as prognostic factors in cervical spondylotic myelopathy. Acta Neurochir. 2010;152(10):1687-94. https://doi.org/10.1007/s00701-010-0692-8 PMid:20512384 DOI: https://doi.org/10.1007/s00701-010-0692-8

Yamazaki T, Yanaka K, Sato H, Uemura K, Tsukada A, Nose T. Cervical spondylotic myelopathy: Surgical results and factors affecting outcome with special reference to age differences. Neurosurgery. 2003;52(1):122-6. https://doi.org/10.1227/00006123-200301000-00015 PMid:12493108 DOI: https://doi.org/10.1227/00006123-200301000-00015

Naderi S, Özgen S, Pamir MN, Özek MM, Erzen C. Cervical spondylotic myelopathy: Surgical results and factors affecting prognosis. Neurosurgery. 1998;43(1):43-9. https://doi.org/10.1097/00006123-199807000-00028 PMid:9657187 DOI: https://doi.org/10.1097/00006123-199807000-00028

Ahn JS, Lee JK, Kim BK. Prognostic factors that affect the surgical outcome of the laminoplasty in cervical spondylotic myelopathy. Clin Orthop Surg. 2010;2(2):98-104. https://doi.org/10.4055/cios.2010.2.2.98 PMid:20514267 DOI: https://doi.org/10.4055/cios.2010.2.2.98

Göçmez C, Koc RK, Tucer B, Menku A, Kurtsoy A. Prognostic factors in cervical spondylotic myelopathy: A clinical prospective study. Neurosurg Quarterly. 2015;25(1):34-40. https://doi.org/10.1097/wnq.0b013e3182a2fe31 DOI: https://doi.org/10.1097/WNQ.0b013e3182a2fe31

Kohno K, Kumon Y, Oka Y, Matsui S, Ohue S, Sakaki S. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol. 1997;48(3):237-45. https://doi.org/10.1016/s0090-3019(97)00166-3 PMid:9290710 DOI: https://doi.org/10.1016/S0090-3019(97)00166-3

Morio Y, Yamamoto K, Kuranobu K, Murata M, Tuda K. Does increased signal intensity of the spinal cord on MR images due to cervical myelopathy predict prognosis? Arch Orthop Trauma Surg. 1994;113(5):254-9. https://doi.org/10.1007/bf00443813 PMid:7946816 DOI: https://doi.org/10.1007/BF00443813

Yone K, Sakou T, Yanase M, Ijiri K. Preoperative and postoperative magnetic resonance image evaluations of the spinal cord in cervical myelopathy. Spine. 1992;17:S388-92. https://doi.org/10.1097/00007632-199210001-00008 PMid:1440032 DOI: https://doi.org/10.1097/00007632-199210001-00008

Okada Y, Ikata T, Yamada H, Sakamoto R, Katoh S. Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine. 1993;18(14):2024-9. https://doi.org/10.1097/00007632-199310001-00016 PMid:8272953 DOI: https://doi.org/10.1097/00007632-199310001-00016

Matsuda Y, Miyazaki K, Tada K, Yasuda A, Nakayama T, Murakami H, et al. Increased MR signal intensity due to cervical myelopathy: Analysis of 29 surgical cases. J Neurosurg. 1991;74(6):887-92. https://doi.org/10.3171/jns.1991.74.6.0887 PMid:1903439 DOI: https://doi.org/10.3171/jns.1991.74.6.0887

Edwards CC, Heller JG, Murakami H. Corpectomy versus laminoplasty for multilevel cervical myelopathy: An independent matched-cohort analysis. Spine. 2002;27(11):1168-75. https://doi.org/10.1097/00007632-200206010-00007 PMid:12045513 DOI: https://doi.org/10.1097/00007632-200206010-00007

Kristof RA, Kiefer T, Thudium M, Ringel F, Stoffel M, Kovacs A, et al. Comparison of ventral corpectomy and plate-screw-instrumented fusion with dorsal laminectomy and rod-screw-instrumented fusion for treatment of at least two vertebral-level spondylotic cervical myelopathy. Eur Spine J. 2009;18(12):1951-6. https://doi.org/10.1007/s00586-009-1110-x PMid:19662441 DOI: https://doi.org/10.1007/s00586-009-1110-x

Lemus MA, Bustamante AE, Muciño AO, Hernandez GC. Clinical outcome of anterior vs posterior approach for cervical spondylotic myelopathy. J Orthop. 2016;13(3):123-6. https://doi.org/10.1016/j.jor.2016.03.006 PMid:27076742 DOI: https://doi.org/10.1016/j.jor.2016.03.006

Xu L, Sun H, Li Z, Liu X, Xu G. Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: A meta-analysis. Int J Surg. 2017;48:247-53. https://doi.org/10.1016/j.ijsu.2017.06.030 PMid:28687344 DOI: https://doi.org/10.1016/j.ijsu.2017.06.030

Konya D, Ozgen S, Gercek A, Pamir MN. Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy. J Clin Neurosci. 2009;16(3):404-9. https://doi.org/10.1016/j.jocn.2008.07.070 PMid:19153044 DOI: https://doi.org/10.1016/j.jocn.2008.07.070

Nirala AP, Husain M, Vatsal DK. A retrospective study of multiple interbody grafting and long segment strut grafting following multilevel anterior cervical decompression. Br J Neurosurg. 2004;18(3):227-32. https://doi.org/10.1080/0268869041000173 2643 PMid:15327222 DOI: https://doi.org/10.1080/02688690410001732643

Cabraja M, Oezdemir S, Koeppen D, Kroppenstedt S. Anterior cervical discectomy and fusion: Comparison of titanium and polyetheretherketone cages. BMC Musculoskeletal Disord. 2012;13(1):172. https://doi.org/10.1186/1471-2474-13-172 PMid:22978810 DOI: https://doi.org/10.1186/1471-2474-13-172