Surgical treatment for cervical spondylotic myelopathy shows sustained clinical improvement

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Michael Fehlings, Toronto Western Hospital and University of Toronto Spine Program, Canada presented on the two year outcomes of a large prospective multicentre study, run by SpineNET— the clinical research network of AOSpine North America— which evaluated the impact of surgery on outcomes of cervical spondylotic myelopathy. His paper was in the Best Papers session at the North American Spine Society annual meeting in Orlando, Florida.

Cervical spondylotic myelopathy is the commonest cause of spinal cord impairment and yet surprisingly there is a relative paucity of evidence documenting the outcomes of treatment,” said Fehlings, adding that the aim was “to document whether the early improvements with surgery are indeed sustained at two years”.

 

Two hundred and eighty patients with clinically confirmed cervical spondylotic myelopathy and imaging evidence of cord compression (MRI or CT-myelogram) were enrolled in the prospective cohort study.

 

Patients underwent a variety of approaches through anterior and posterior techniques; anterior surgery (discectomy/corpectomy and instrumented fusion) or posterior surgery (laminectomy and fusion or laminoplasty) based on the judgment of the operating surgeon. Outcomes were assessed by several disease specific and generic outcomes instruments including the modified Japanese Orthopedic Assessment (mJOA) assessment scale, the Nurick scale, the Neck Disability Index (NDI) and the SF-36.

 

Two hundred and eighty subjects were enrolled at 12 sites. Twelve month follow-up data were available for 228 of 260 eligible subjects (87%) and 24 month follow-up data are available for 191 subjects of 254 eligible subjects (76%). Five patients (1.8%) experienced worsening spinal cord function and seven patients (2.5%) had nerve root problems.  Of the wound infections, seven (2.5%) were superficial and one (0.4%) was deep. To treat analysis, patients with cervical spondylotic myelopathy achieved significant improvements in all outcome measures at one year which were sustained at two years.

 

“Surgical treatment for cervical spondylotic myelopathy results in sustained improvement in generic and disease health-related quality of life and these improvements are sustained up to two years,” said Fehlings.

 

Similar improvements were seen with anterior or posterior approaches for cervical spondylotic myelopathy; however, key differences exist in the types of patients treated with 1–2 level focal pathology (anterior surgery) and multilevel disease (posterior surgery), he concluded.

 

 

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