gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

Cervical spondylotic myelopathy – When should we operate?

Zervikale Myelopathie – Wann sollten wir operieren?

Meeting Abstract

  • presenting/speaker Oliver Gembruch - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ramazan Jabbarli - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Lennart Barthel - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Ulrich Sure - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland
  • Neriman Oezkan - Universitätsklinikum Essen, Klinik für Neurochirurgie, Essen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocV158

doi: 10.3205/19dgnc185, urn:nbn:de:0183-19dgnc1852

Published: May 8, 2019

© 2019 Gembruch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Cervical spondylotic myelopathy (CSM), a slowly ongoing disease, is the most common reason for spinal cord injuries. Up to now, timing of surgical treatment still varies. In this study we analyzed the postoperative outcome of patients suffering from CSM with and without signs of myelopathy on T2-weighted magnetic resonance images (MRI) to evaluate the neurological improvement in order to predict surgical timing. Additionally, correlation between time until correct diagnosis and preoperative status and postoperative outcome was analyzed to evaluate the impact of the time on the pre- and postoperative neurological function.

Methods: Clinical and radiological data of patients, who were treated in our department between 2007 and 2016, suffering from a clinical CSM were analyzed retrospectively. 412 patients met the inclusion criteria and 248 patients presented an additional sign of myelopathy on T2- weighted MRI-Scans. The modified Japanese Orthopaedic Association Score (mJOA), the mean postoperative achievement of mJOA and the neural recovery rate (NRR) were used to define the pre- and postoperative neurological function. Patients with and without additional signs of myelopathy were compared using different age-dependent groups regarding the mJOA score, the mean mJOA achievement and the NRR.

Results: All patients improved significantly after surgery (p<0.0001), but older patients and patients with a sign of myelopathy showed a significant lower preoperative (G1: 14.99±2.17, G2: 14.57±2.27, G3: 13.57±2.51) and postoperative mJOA score compared to younger patients and patients without a sign of myelopathy (p<0.0001). The NRR was significantly lower in those patients (p<0.0001), but the median mJOA score achievement did not differ significantly (G1: 1.95±1.04, G2: 2.01±1.04, G3: 2.00±0.91) between those groups (p=0.067). Longer time finding the correct diagnosis correlates significantly with a lower preoperative status and therefore with a lower postoperative mJOA score in elderly patients (p<0.0001).

Conclusion: Elderly patients and patients with a positive sign of myelopathy show lower pre- and postoperative mJOA scores than younger patients and patients without a sign of myelopathy. Longer time until surgery in elderly patients correlates with lower pre- and postoperative mJOA scores. Therefore, patients should be operated as early as possible and before a sign of myelopathy is present on MRI.