Title: Clinical Evaluation of Cervical Spondylotic Myelopathy in Pre and Post op Period

Authors: R Srinivas, Shikhil Uppal Andan*, YS Chandan, P Rajmane

 DOI: https://dx.doi.org/10.18535/jmscr/v7i1.176

Abstract

In this present study, we evaluated the clinical signs and symptoms of 30 patients with cervico-spondylo-myelopathy in pre and post-operative period for a span of 3 months with the help of modified Japanese orthopaedic association score. Cervico-spondylo-myelopathy were confirmed by neurological examinations and imaging studies (X-ray, CT and MRI). All patients underwent anterior cervical discectomy with titanium cage fusion. We used modified JOA scoring system for cervical myelopathy and a score of less than 12 indicates severe disability. No mortality was noted after surgery and the surgical technique reveal clinical improvement in 50 % patient after 3 months time. Majority of the patients had a better outcome at 3 months 23 (76%) had a score of more than 12. Any gross improvement can be expected only after 3 months and the surgical technique has a very low morbidity and mortality rate. 

Keywords: Anterior cervical discectomy, preoperative, post operative period, cervical spondylosis.

References

  1. Baptiste DC, Fehlings MG. Pathophysiology of cervical myelopathy. The Spine Journal. 2006 Nov 1;6(6):S190-7.
  2. Bakhsheshian J, Mehta VA, Liu JC. Current diagnosis and management of cervical spondylotic myelopathy. Global spine journal. 2017 Sep;7(6):572-86.
  3. Boni M, Cherubino P, Denaro V, Benazzo F: Multiple subtotal somatectomy. Technique and evaluation of a series of 39 cases. Spine (Phila Pa 1976) 9(4):358-362, 1984.
  4. Kadanka Z, Mares M, Bednanik J, et al. Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine (Phila Pa 1976). 2002;27: 2205-2210.
  5. Kato S, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, Kawamura N, Masuda K, Kunogi J, Okazaki R, Azuma S. Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (mJOA) score for the assessment of cervical myelopathy: a multicenter observational study. PLoS One. 2015 Apr 2;10(4):e0123022.
  6. Liu Y, Hou Y, Yang L, Chen H, Wang X, Wu X, Gao R, Wang C, Yuan W. Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine. 2012 Nov 1;37(23):E1450-8.
  7. Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, Holly LT, Ryken TC, Choudhri TF, Vresilovic EJ, Resnick DK. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. Journal of Neurosurgery: Spine. 2009 Aug;11 (2):130-41.
  8. Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG. Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine. 2015 Jun 15;40(12):E675-93.
  9. Park SJ, Kim SB, Kim MK, Lee SH, Oh IH. Clinical features and surgical results of cervical myelopathy caused by soft disc herniation. Korean Journal of Spine. 2013 Sep;10(3):138.
  10. Rhee JM, Shamji MF, Erwin WM, et al. Nonoperative management of cervical myelopathy: a systematic review. Spine (Phila Pa 1976). 2013;38(22 suppl):S55-S67.  
  11. Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). 2000;25:670-676.
  12. Shedid D, Benzel EC. Cervical spondylosis anatomy pathophysiology and biomechanics. Neurosurgery. 2007 Jan 1;60(suppl_1):S1-7.
  13. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. The neurologist. 2010 May 1;16(3):176-87.
  14. Yoshor D, Klugh III A, Appel SH, Haverkamp LJ. Incidence and characteristics of spinal decompression surgery after the onset of symptoms of amyotrophic lateral sclerosis. Neurosurgery. 2005 Nov 1;57(5):984-9.
  15. Yoshimatsu H, Nagata K, Goto H, et al. Conservative treatment for cervical spondylotic myelopathy. prediction of treatment effects by multivariate analysis. Spine J. 2001;1:269-273.

Corresponding Author

R Srinivas

Department of Surgery, Sri Ramachandra Institute of Higher Education and Research,

Formerly Sri Ramachandra University, Porur, Chennai, India