[Cervical spondylotic myelopathies. Apropos of 121 cases. Prognostic value of sensitive symptoms]

121 patients have been treated for cervical spondylotic myelopathy between 1972 and 1985; 88 patients have been operated on, most of them (84) by laminectomy and 4 cases by anterior approach; 33 patients have been treated conservatively in absence of evolution. We have used a clinical classification based on the different sensitive symptoms, the best predictive factor in our opinion; the typical form (2/3 of all cases) associates numbness and paresthesias of extremities of both hands, difficulties for manipulation, astereognosia, with a moderate pyramidal deficit of the lower limbs; this typical form obtains the best post-operative score with 75% of good results; the more the clinical sensitive form is far from the typical one, the poorest may be the evolution. Our results are similar with large series of literature, using either the posterior or the anterior approach; we have noted the frequency (1/4 of cases) of very late worsening, several years after initial good result, without residual compressive factor; it is supposed that organised intra-medullary lesions, may be of venous origin, continue to evolve for their own. 33 non operated patients have been treated conservatively, because of spontaneous stabilization of their disease, suggesting to try immobilization by cervical collar during few weeks before surgery.