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. 2008 Apr;32(2):273-8.
doi: 10.1007/s00264-006-0315-4. Epub 2007 Jan 19.

Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study

W Y Cheung  1 , D Arvinte, Y W Wong, K D K Luk, K M C Cheung
Affiliations

Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study

W Y Cheung et al. Int Orthop. 2008 Apr.

Abstract
in English, French

Cervical spondylotic myelopathy is a common clinical problem. No study has examined the pattern of neurological recovery after surgical decompression. We conducted a prospective study on the pattern of neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy. Patients suffering from cervical spondylotic myelopathy and requiring surgical decompression from January 1995 to December 2000 were prospectively included. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Assessment was done before the operation, at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly after surgery. Results were analysed with the t-test. Differences with P-values less than 0.05 were regarded as statistically significant. Fifty-five patients were included. The average follow-up period was 53 months. Thirty-nine patients (71%) had neurological improvement after the operation with a mean recovery rate of 55%. The JOA score improved after surgery, reaching statistical significance at 3 months and a plateau at 6 months. Thirty-six patients (65%) had improvement of upper limb function. Twenty-four patients (44%) had improvement of lower limb function. Eleven patients (20%) had improvement of sphincter function. The recovery rate of upper limb function was 37%, of lower limb function was 23% and of sphincter function was 17%. Surgical decompression worked well in patients with cervical spondylotic myelopathy. Seventy-one percent of patients had neurological improvement after the operation. The neurological recovery reached a plateau at 6 months after the operation. The upper limb function had the best recovery, followed by lower limb and sphincter functions.

Les myélopathies cervicales sont un problème courant. Aucune étude n’a examiné la récupération neurologique après décompression chirurgicale. Nous avons conduit une étude prospective sur ce sujet, chez des patients ayant bénéficié d’une décompression pour myélopathie cervicale. Les patients opérés entre janvier 1995 et décembre 2000 ont été inclus dans cette étude. Les fonctions des membres supérieurs, des membres inférieurs et les fonctions sphinctériennes ont été évaluées selon le score de la JOA (Association Japonaise d’Orthopédie). L’évaluation a été réalisée avant l’opération, une semaine, deux semaines, un mois, trois mois, six mois, un an et chaque année après l’intervention chirurgicale. Les résultats ont été analysés selon le P test et en appréciant ensuite les résultats statistiquement ou non statistiquement significatifs. Cinquante-cinq patients ont été inclus. Le suivi moyen a été de 53 mois, 39 patients (71%) ont montré une amélioration neurologique après l’intervention avec un taux de récupération complète de 55%. Le score de la JOA a été amélioré à 3 mois avec un plateau de récupération à 6 mois. Trente-six patients (65%) ont vu une amélioration au niveau des fonctions du membre supérieur, 24 (44%) au niveau des membres inférieurs, 11 (5%) au niveau des fonctions sphinctériennes. Le taux de récupération au niveau des membres supérieurs a été de 37%, pour les membres inférieurs de 23% et pour les fonctions sphinctériennes de 17%. La décompression chirurgicale des myélopathies cervicales est une opération intéressante; 71% des patients ont vu une amélioration neurologique après l’intervention. Cette récupération atteint un plateau six mois après l’intervention. La récupération des membres supérieurs est la plus importante, suivie de la récupération des membres inférieurs puis de la récupération sphinctérienne. Mots clés : myélopathie cervicale, récupération neurologique.

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Figures

Fig. 1
Fig. 1
Change of JOA scores with time after surgical decompression. JOABO: JOA score before operation; JOA1W: JOA score at 1 week; JOA2W: at 2 weeks; JOA1M: at 1 month; JOA3M: at 3 months; JOA6M: at 6 months; JOA1Y: at 1 year; JOAF: at final
Fig. 2
Fig. 2
Change of upper limb function with time after surgical decompression. UFBO: upper limb function score before operation; UF1W: upper limb function score at 1 week; UF2W: at 2 weeks; UF1M: at 1 month; UF3M: at 3 months; UF6M: at 6 months; UF1Y: at 1 year; UFF: at final
Fig. 3
Fig. 3
Change of lower limb function score with time. LFBO: lower limb function score before operation; LF1W: Lower limb function score at 1 week; LF2W: at 2 weeks; LF1M: at 1 month; LF3M: at 3 months; LF6M: at 6 months; LF1Y: at 1 year; LFF: at final
Fig. 4
Fig. 4
Change of sphincter function score with time. SFBO: Sphincter function before operation; SF1W: sphincter function at 1 week; SF2W: at 2 weeks; SF1M: at 1 month; SF3M: at 3 months; SF6M: at 6 months; SF1Y: at 1 year; SFF: at final
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