gms | German Medical Science

Objective: Myelopathy is often associated with pathologies of the cervical spine. But incidence and long-term history of this condition remains unclear with controversial reports about it. We have analysed 177 patients undergoing posterior spinal cord decompression plus instrumentation due to traumatic, tumoral, spondylotic and infectious pathologies. The aim of our study was to investigate clinical and neurological status with emphasis on myelopathy condition and quality of life.

Method: From 2006 to 2012 posterior cranio-cervical, cervical or cervico-thoracic decompression plus spondylodesis were performed in 177 patients. For instrumentation we have a used screw-rod system with lateral mass-, isthmus- (C1 to C6) or pedicle screws (C7 and thoracic). CT scans were performed pre-, postoperatively and during follow-up. We have used for clinical assessment the Visual Analogue Scale (VAS), the modified Japanese Orthopaedic Association score (mJOA), Nurick score and the Neck Pain Disability Index (NPDI).

Results: Patient's age was in median 65.2y (68 %-CI: 42.1 - 77.8y.). There were 113 male patients (64 %) and 64 female patients (36 %, p = 0.11, U-Mann-Whitney test). The distribution of pathologies was: spondylotic (n = 58, 32.9 %), traumatic (n = 55, 30.9 %), tumoral (n = 33, 18.5 %), and infectious (n = 31, 17.2 %), p = 0.15 (U-Mann-Whitney test). Patients were followed-up in median 24.3 months (range: 3 - 48 m.) Myelopathy was observed pre-operatively in 83 patients (47 %), showing in 22 of them a severe grade (mJOA > 12). It improved moderately one week after surgery (78 patients, 44 %) and at 3 months follow-up (74 patients, 42 %). At 6 months, a spontaneous increase of one Nurick-grade was observed in 4 patients (79 patients, 45 %). During follow-up, patients showed an improvement in pain condition (pre-op. 78 %, post-op. 45 %, p < 0.05), in motor deficits (pre-op. 45 %, post-op. 15 %, p > 0.05) and dysesthesias (pre-op. 44 %, post-op. 35 %, p > 0.05). 53 % of the patients returned to work and to sports activities.

Conclusions: Myelopathy remains a concern in many of pathologies of the cervical spine. Our results strongly suggest that even after decompressive surgery, rates and severity of myelopathy do not considerably change, probably due to the pathophysiology of the disease involving biological and mechanical factors. Nevertheless, surgery is the treatment of choice, especially in moderate to severe cases and leads to recovery of pain and in a lesser extent of motor deficits.