gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Literature review and critical analysis of long-term surgical results for cervical myelopathy: are evoked potentials or MRI of predictive value in evaluation of the long-term surgical results?

Meeting Abstract

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  • corresponding author E. Emery - Service de Neurochirurgie, CHU de Caen, France

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocRT.08.02

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Veröffentlicht: 4. Mai 2005

© 2005 Emery.
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Debate over the management of cervical spondylotic myelopathy (CSM) continues. Controversy remains regarding whether treatment should be nonoperative or operative, and wether a dorsal or ventral approach is indicated. The use of computed tomography and magnetic resonance imaging has provided an early diagnosis of CSM and definition of new operative criteria regarding the surgical decision-making process has emerged. Nontheless, a variety of factors have been reported to affect post-operative outcome and they may predict post-operative good or poor results even though these factors are not always well analysed in long-term follow-up after surgery. The purpose of these work was to critically review the literature of long-term surgical results for CSM and try to clarify whether clinical, epidemiological, radiological or electrophysiological factors may affect post-operative results. Over 100 papers were analysed through Medline with a selection of english or french written papers. The key-words were cervical myelopathy- surgery- results- prognostic factors-MRI- evoked potentials.

Most of the papers are related to retrospective clinical series and a minority are specially focused on long-term results. More than half papers were published by japonase authors who mixed two pathologies (cervical myelopathy and ossification of posterior longitudinal ligament OPLL). The surgical techniques used were either anterior corpectomy (multilevel and arthrodesis), or posterior approaches (multilevel laminectomy +/- arthrodesis, multilevel laminoplasty). The evaluation was based on clinical parameters (functional scales mainly Japonase Orthopaedic Association functional scale (or the modified one)- Nurick scale), radiological parameters (plain X-rays, MRI), electrophysiological parameters (somatosensory evoked potentials (SEPs), motor evoked potentials (MEPs).

Review of the literature showed 59 to 85% improvement after cervical laminectomy. It seems that the long-term results after laminectomy decreases because of the progression of the spondylotic process after surgery and changed biomechanics of the cervical spine, especially in cases with pre-operative abnormal cervical curvature. The presence of abnormal cervical curvature correlated with less neurological improvement. Age, symptom duration, preoperative high signal intensity within the spine may result in less improvement.

Review of the literature showed 58 to 82% improvement after cervical laminoplasty. In the long-term, lost range of motion caused by facet arthodesis may be a potential disadvantage as compared to laminectomy. Controversy still remains over whether laminoplasty is superior to laminectomy, and whether laminoplasty is necessary for the elderly population. Review of the literature showed 70 to 86% improvement after cervical anterior decompression and arthrodesis. Most authors limited the anterior approach to three-level corpectomies and complications rate seems higher compared to posterior approaches, especially in older patients.

There is no clear evidence in this literature review about prognostic factors: neither age, clinical symptoms, pre-operative JOA score, signal intensity on MRI, the transverse area of the spinal cord at the level of maximum compression are predictive of more or less successful outcomes. MEPs were more sensitive than SEPs in detecting central conduction impairements in patients with either pure or preclinical cervical myelopathy and may be of good predictive value for surgical outcome.