Cervical compression myelopathy: is fusion the main prognostic indicator?

Area of Science:

• Neurosurgery
• Spinal Surgery
• Orthopedics

Background:

• Cervical compression myelopathy (CCM) can lead to neurological deficits.
• Surgical decompression is the primary treatment for CCM.
• Prognostic factors for neurological improvement after CCM surgery are not fully understood, especially with suboptimal decompression.

Purpose of the Study:

• To identify prognostic factors for neurological improvement in CCM patients after surgery.
• To analyze outcomes in patients with insufficient spinal canal decompression.

Main Methods:

• Prospective follow-up of 20 consecutive CCM patients treated between 2000-2002.
• Anterior surgical approaches: anterior cervical discectomy and fusion or cervical corpectomy and fusion with instrumentation.
• Outcomes assessed using modified Japanese Orthopaedic Asssociation scale, MRI, CT, and radiography.

Main Results:

• 85% of patients (17/20) achieved ≥50% recovery rate (Hirabayashi formula) over a mean 32.5-month follow-up.
• Significant recovery occurred despite persistently narrow spinal canals and persistent/increased intramedullary high-intensity signals post-surgery.
• Neurological improvement was not correlated with the reversal or decrease of intramedullary high-intensity signals.

Conclusions:

• Anterior cervical discectomy and fusion or corpectomy with instrumentation benefit CCM patients, even with insufficient decompression.
• Spinal fusion at the affected level(s) may contribute to high recovery rates.
• Neurological recovery in CCM is independent of intramedullary signal changes post-operatively.