Cervical spondylotic myelopathy: 10 years of treatment experience

Introduction. Cervical spondylotic myelopathy (CSM) results from prolonged cervical stenosis and is characterized by severe neurological disturbances. Given the high degree of disability and the ineffectiveness of conservative treatment for CSM, spinal decompression surgery is preferable. Two surgical treatment approaches are currently in competition — laminoplasty and corpectomy.

The study aimed to analyze the early (1 day after surgery) and long-term (12, 60, and 120 months after surgery) clinical, radiological, and neuroimaging results of CSM surgery.

Materials and methods. Two hundred and twenty-six patients (91 women and 135 men, average age 48.1 years) with degenerative cervical spinal stenosis accompanied by myelopathy underwent surgery. Pain severity (VAS score), proprioception (M. Doita’s scale), ability to perform self-care (Nurick scale), and recovery after surgery (JOA scale) were clinically evaluated. The stability of the cervical spine was evaluated radiologically. Stenosis severity and myelopathy lesions were assessed based on the neuroimaging data.

Results. Early and long-term clinical, radiological, and neuroimaging results were evaluated. Neck pain was 0–3 points on the VAS in the long-term (12, 60, and 120 months after surgery), decreasing from the initial 6–8 points. The JOA scale results showed that the efficacy of myelopathy treatment directly depended on disease history and the timing of surgical intervention. According to the Nurick scale, there was a tendency towards significant improvement in neurological status in patients with moderate disease. In contrast, the neurological status improved or remained stable in patients with the more pronounced disease, but this required more time. Improvement in proprioception as measured by the M. Doita scale was observed in patients at all stages of the disease.

Conclusion. Both surgical methods (laminoplasty and corpectomy) lead to good outcomes in CSM treatment. The effectiveness of surgical treatment for CSM directly depends on the disease duration and timing of the decompression surgery. Recovery is better when clinical symptoms of CSM are mild, moderate, and moderately severe and with a timely presentation to a surgeon.