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Research indicates that surgery improves outcome in Patients with Cervical Spondylotic Myelopathy

Newswise — Degenerative changes in the neck are part of the normal process of aging and affect nearly everyone age 40 and older to some degree.

But a serious condition called cervical spondylotic myelopathy (CSM), typically affecting those age 50 and older, can lead to partial paralysis.

CSM is the most common cause of spinal cord dysfunction in people age 55 and older.

In advanced stages, these degenerative changes can cause narrowing of the spinal canal, leading to thickening of the posterior longitudinal ligament and bone spur (osteophyte) formation.

This can cause chronic compression of the spinal cord and nerve roots, most commonly at C5-C7 levels, which may impair blood flow, create neurological deficits, and result in permanent damage to the spinal cord.

Symptoms of CSM can include weakness or stiffness in the legs, unsteadiness in gait, neck stiffness, unilateral or bilateral penetrating neck pain, numb or tingling hands, arm and shoulder pain, extremity motor weakness, and bowel and bladder dysfunction.

The symptoms may develop slowly – remain the same for long periods of time – followed by episodes in which they worsen.

Because many of these symptoms are common to other conditions like multiple sclerosis or amyotrophic lateral sclerosis, the first step is to make a proper diagnosis.

Patients with these symptoms should get a thorough neurological exam, be checked for differential symptoms, and receive the imaging modality of choice – MRI.

Although CSM is a common cause of spinal cord dysfunction, there is a very little outcome data available validating the role of surgical intervention in treating patients with this condition,” said Michael G. Fehlings, MD, PhD, FRCSC, FACS, head of the Krembil Neuroscience Center at the University Health Network in Toronto and professor of Neurosurgery at the University of Toronto.

Researchers across multiple North American sites analyzed outcome in patients with CSM who had undergone surgical intervention.

The results of this study, Surgical Treatment is Effective for Cervical Spondylotic Myelopathy: One Year Outcomes of a Multi-Center Prospective Study, with Independent Assessment, in 294 Patients, will be presented by Dr. Fehlings,  during the 77th Annual Meeting of the American Association of Neurological Surgeons in San Diego. Co-authors are Paul Arnold, MD, Darrel Brodke, MD, Jens Chapman, MD, Michael Jannsen, DO, Branko Kopjar, MD, PhD, Eric Massicotte, MD, Rick Sasso, MD, Christopher Shaffrey, MD, Tim Yoon, MD, and Alexander Vaccaro, MD, PhD.

A total of 294 subjects have been enrolled at 13 sites across North America. To date, 235 patients (87 percent) have 1-year follow-up data available.

Outcome assessments include the modified Japanese Orthopaedic Association Scale (mJOA), Neck Disability Index (NDI), Nurick score, quantitative assessments of walking speed, SF36 quality of life assessment, and complications.

•Sixty percent of patients are male, 40 percent are female
•Mean age is 57 years
•Fifty-nine percent of patients received anterior surgery, 36 percent posterior and 6 percent a combined “360” approach

The following outcomes have been reported:

•There has been a statistically (P < .01) and clinically significant improvement from baseline values to 12 months in all measured outcome parameters.

•The mJOA scores improved from 13.0 (SD = 2.8) preoperatively to 15.5 (SD = 2.8).

•The NDI scores improved from 41.8 (SD=20.8) to 30.4 (SD = 22.8).

•The average Nurick scores improved from 4.1 (SD = 1.0) to 2.7 (SD = 1.6).

•The 30-meter walk test improved from 29 seconds (SD = 18) to 25 seconds (SD=14).

•The SF36 PCS scores improved from 35 (SD = 9) to 39 (SD = 12) and the SF36 MCS scores improved from 41 (SD = 15) to 47 (SD = 14).

“One-year follow-up results of this large prospective clinical study on CSM patients are encouraging.

"Significant improvements were achieved through surgical intervention based on all outcome measurements,” remarked Dr. Fehlings.

On a related research topic, Dr. Fehlings will present, One Year Outcomes of the STASCIS Study: A Prospective, Multi-Center Trial to Evaluate the Role and Timing of Decompression in Patients with Cervical Spinal Cord Injury.

“The findings in this study represent more complete data in a larger sample of patients with one-year follow-up than presented at last year’s AANS Annual Meeting, said Dr. Fehlings.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,400 members worldwide.

The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public.

All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC.

Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain and peripheral nerves.