Study: Surgery Improves Outcomes in Patients with Cervical Spondylotic Myelopathy

To read a brief explanation of this study—and what it means for patients—click here.

Degenerative changes in the neck are part of the normal process of aging and affect nearly everyone age 40 and older to some degree. But a serious condition called cervical spondylotic myelopathy (CSM), which typically affects people age 50 and older, can lead to partial paralysis.

Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in people age 55 and older. In advanced stages, these degenerative changes can cause narrowing of the spinal canal, leading to the thickening of the posterior longitudinal ligament, (which runs up and down the back of the spine in the spinal canal) and bone spur (osteophyte) formation. This can cause chronic compression of the spinal cord and nerve roots, most commonly at C5-C7 levels (the lower part of your neck), which may impair blood flow, create neurological deficits (nerve problems), and result in permanent damage to the spinal cord.

Symptoms of CSM can include weakness or stiffness in the legs, unsteadiness in gait, neck stiffness, unilateral or bilateral penetrating neck pain, numb or tingling hands, arm and shoulder pain, extremity motor weakness, and bowel and bladder dysfunction.

The symptoms may develop slowly, remain the same for long periods of time, and then eventually worsen. Because many of these symptoms are also common to other conditions, such as multiple sclerosis, the first step is a proper diagnosis. Patients with these symptoms should get a thorough neurological exam, be checked for differential symptoms, and receive the imaging modality of choice—MRI.

"Although CSM is a common cause of spinal cord dysfunction, there is a very little outcome data available validating the role of surgical intervention in treating patients with this condition," said Michael G. Fehlings, MD, PhD, FRCSC, FACS, head of the Krembil Neuroscience Center at the University Health Network in Toronto and professor of Neurosurgery at the University of Toronto.

Researchers analyzed outcomes in patients with CSM who had undergone surgical intervention. The results were published in the study Surgical Treatment is Effective for Cervical Spondylotic Myelopathy: One Year Outcomes of a Multi-Center Prospective Study, with Independent Assessment, in 294 Patients.

A total of 294 subjects were enrolled at 13 sites across North America. To date, 235 patients (87%) have 1-year follow-up data available.

• 60% of patients are male, 40% are female
• Average age is 57 years
• 59% of patients received anterior (from the front) surgery, 36% posterior (from the back), and 6% a combined "360" approach

Outcome assessments include the modified Japanese Orthopaedic Association Scale (mJOA), Neck Disability Index (NDI), Nurick score, quantitative assessments of walking speed, SF36 quality of life assessment, and complications. (These assessments measure how well the patients responded to treatment.)

The following outcomes have been reported:

• There has been a statistically (P <.01) and clinically significant improvement from baseline values to 12 months in all measured outcome parameters.
• The mJOA scores improved from 13.0 (SD = 2.8) preoperatively to 15.5 (SD = 2.8).
• The NDI scores improved from 41.8 (SD=20.8) to 30.4 (SD = 22.8).
• The average Nurick scores improved from 4.1 (SD = 1.0) to 2.7 (SD = 1.6).
• The 30-meter walk test improved from 29 seconds (SD = 18) to 25 seconds (SD=14).
• The SF36 PCS scores improved from 35 (SD = 9) to 39 (SD = 12) and the SF36 MCS scores improved from 41 (SD = 15) to 47 (SD = 14).

"One-year follow-up results of this large prospective clinical study on CSM patients are encouraging," said Dr. Fehlings, who co-authored the study. "Significant improvements were achieved through surgical intervention based on all outcome measurements."

Source:
American Association of Neurological Surgeons
Press Release: May 4, 2009

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