The prognosis of patients with cervical spondylotic myelopathy

We studied 56 patients who received complete neurological examinations, image studies, or electrophysiological studies, and for these cervical spondylotic myelopathy was diagnosed at the Kaohsiung Medical College Hospital during the period 1988 to 1993. For the purposes of identifying possible prognosis factors and comparing the results of patients with conservative treatment versus operative treatment, we designed this study. Informed consent and a completed functional evaluation were obtained from 31 patients via physiatrist's visits. 17 patients (male = 11, female = 6) mean age 52 years old received conservative treatment and 14 patients (male = 11, female = 3) mean age 50 years old received operative treatment. For the conservative group, the average follow-up was 54 months and for the operative group, the average duration (from symptom and sign onset until operation) was 23 months. According to "The Japanese Orthopaedic Association Scale" and "The Recovery Rate Scale", we have evaluated the functional change of patients during the follow-up period and different possible prognosis factors have been analyzed. There is no significant difference in recovery rate whether patient's age is over 50 years old or whether the individual Pavlov ratio is smaller than 0.7. Interestingly, patients who received operation (anterior or posterior approach) within 18 months since symptom and sign onset were found to have a better recovery rate (p = 0.03). In our study, conservative management leads to 35% improvement and the operative management leads to 43% improvement. The results of proper cases selection and operation are superior to conservative treatment. If a patient has received a conservative treatment, routine re-evaluation is then very important for the early detection of progressive compression myelopathy signs.