gms | German Medical Science

Objective: Cervical myelopathy constitutes a common degenerative disease of the cervical spine. This study compares results for patients treated by decompression and fusion over a minimum of 3 spinal levels comparing patients without (group A) and with a previous spinal cord disease (group B).

Methods: Since 2005, 27 patients (16 males, 11 females) were operated for progressive cervical myelopathy with multisegmental decompression and fusion. 24 operations were performed from posterior, 1 ventral decompression was used and 2 patients underwent dorsoventral operations. 12 patients belonged in group A without a spinal cord affection prior to the degenerative disease, 15 patients presented with a progressive myelopathy on top of a previous spinal cord problem (group B): 13 patients suffered from syringomyelia, while one patient had recovered from poliomyelitis and one had been diagnosed with multiple sclerosis. The clinical course was evaluated with the European myelopathy score (EMS) and the myelopathy score of the Japanese orthopaedic society (JOA).

Results: Patients of group A were significantly older (67 ± 14 years) compared to group B (56 ± 11 years) (p = 0.02) but demonstrated a shorter history (11 ± 13 months) compared to group B (62 ± 135 months) (not significant). Before surgery, patients of group A presented significantly better EMS (12.8 ± 2.4) and JOA (11.8 ± 3.1) scores compared to group B (EMS: 10.9 ± 3.4; JOA: 8.5 ± 4.8) (p = 0.03). Average follow-up was 13 ± 21 months. Postoperatively, 17 patients reported improvement, whereas 8 patients remained unchanged and 1 patient worsened. 6 of 8 patients with an unchanged condition belonged to group B. The postoperative scores were significantly better for group A (EMS: 14.2 ± 2.6, JOA 13.4 ± 3.4) compared to group B (EMS: 11.3 ± 3.3, JOA 8.7 ± 4.6) (p = 0.005).

Conclusions: The multilevel decompression and fusion is an effective treatment for progressive cervical myelopathy related to degenerative disease of the cervical spine. For patients with a pre-existing chronic spinal cord disorder (group B) stabilization of the neurological status is achievable. In this study, patients without such a preexisting spinal cord problem (group A) improved significantly despite their more advanced age. This underlines the necessity to monitor patients with chronic spinal cord diseases carefully for degenerative problems of the cervical spine because of reduced functional reserve.