Rationales for a Urodynamic Study in Patients with Cervical Spondylotic Myelopathy

Detrusor sphincter dyssynergia, involuntary detrusor contractions (IDCs), and poor bladder compliance are common urodynamic findings in cervical spondylotic myelopathy (CSM). There is little information regarding the role of a urodynamic study after decompression surgery for CSM.

Urodynamic study was performed before and 6 months after decompression of CSM. Japanese Orthopaedic Association score for cervical myelopathy and Neck Disability Index functional score were applied. International Prostate Symptom Score was applied in male patients, and 6-item Urogenital Distress Inventory was applied in female patients.

Mean patient age was 61.3 years. Final follow-up was obtained in 17 of 32 patients. Neurogenic bladder was confirmed in 11 (64.7%) patients, with 7 patients having poor bladder compliance, 3 patients having IDCs, and 6 patients having detrusor sphincter dyssynergia. Poor bladder compliance was normalized in 4 of 7 patients. IDCs disappeared in 2 (phasic IDCs) of 3 patients and improved in 1 (terminal IDC) patient. Detrusor sphincter dyssynergia markedly improved in 4 of 6 patients. Bladder compliance in 17 patients was 45.52 ± 23.71 before decompression surgery and 77.07 ± 39.85 after decompression surgery (P = 0.004). Both Japanese Orthopaedic Association and Neck Disability Index scores improved (P = 0.007 and P = 0.001, respectively). International Prostate Symptom Score and 6-item Urogenital Distress Inventory were not changed 6 months after surgery.

Neurogenic bladder could be partially controlled in patients with CSM after surgical decompression. The neurogenic component in the urodynamic study findings varied. Depending on the findings, further appropriate urologic treatments after neurologic decompression surgery should be considered.