[01] Farzad Omidi-Kashani, Orthopedic Research Center, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. [02] Mohamed Hosein Ebrahimzadeh, Orthopedic Research Center, Orthopedic Department, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. [03] Arezoo Naderimoghadam, Student Research Committee, Faculty of Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. [04] Hamid Amanzadeh, Orthopedic Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Cervical spondylotic Myelopathy (CSM) is one of the most common causes of cervical spinal cord dysfunction in old patents and in those cases with refractory complains, surgical decompression may become necessary. We aim to evaluate the impact of preoperative spinal cord signal change and symptom duration on surgical outcome of these patients. Material & Method: In this retrospective study, we reviewed 36 patients (25 male and 11 female) with CSM and mean age 55.7±13.2 who were surgically treated in our orthopedic department. Preoperative duration of myelopathic symptoms, disability status (according to Neck Disability Index; NDI), signal change inside the cervical spinal cord (on T2-weighted magnetic resonance imaging; T2 MRI), and surgical outcome (based on Odom’s criteria) were especially assessed. Statistical Package for the Social Sciences (SPSS) software version 16 was used for statistics and P value<0.05 was interpreted as significance. Results: Mean duration of preoperative symptoms and follow-up periods were 17.5±7.9 and 37.5±8 months, respectively. Spinal cord signal intensity in T2 MRI was normal in 21 (58.3%), light in 9 (25%), and tense in 6 (16.7%). Surgery could improve NDI scores from 27±9.3 preoperatively to 11.4±12 at the last follow-up visit. Excellent or good surgical outcome could achieve in 28 patients (77.8%). Among the various patients’ characteristics, only preoperative symptom duration and cord enhancement could show a significant correlation with patient’s disability improvement and surgical outcome. Conclusions: Outcome of surgery in CSM is satisfactory in most of the patients although, preoperative duration of myelopathic symptoms and spinal cord signal enhancement were associated with lower disability improvement and poorer surgical outcome.

Spondylosis, Cervical Cord, Outcome Assessment, Magnetic Resonance Imaging

[01] Ferrara LA. The biomechanics of cervical spondylosis. Adv Orthop. 2012; 2012: 493605. [02] Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010; 16(3): 176-87. [03] Matz PG, Anderson PA, Holly LT, et al. The natural history of cervical spondylotic myelopathy. J Neurosurg Spine. 2009; 11(2): 104-11. [04] Morishita Y, Hida S, Miyazaki M, et al. The effects of the degenerative changes in the functional spinal unit on the kinematics of the cervical spine. Spine. 2008; 33(6): E178-82. [05] Hsu CY, Cheng CY, Lee JD, et al. Clinical features and outcomes of spinal cord infarction following vertebral artery dissection: a systematic review of the literature. Neurol Res. 2013; 35(7): 676-83. [06] Sah S, Wang L, Dahal M, Acharya P, Dwivedi R. Surgical management of cervical spondylotic myelopathy. JNMA J Nepal Med Assoc. 2012; 52(188): 172-7. [07] Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases. J Neurosurg Spine 2011; 14(3): 348-55. [08] Karpova A, Arun R, Davis AM, et al. Predictors of Surgical Outcome in Cervical Spondylotic Myelopathy. Spine 2013; 38(5): 392-400. [09] Naderi S, Ozgen S, Pamir MN, Ozek MM, Erzen C. Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 1998; 43(1): 43-9; discussion 49-50. [10] Tetreault LA, Nouri A, Singh A, Fawcett M, Fehlings MG. Predictors of outcome in patients with cervical spondylotic myelopathy undergoing surgical treatment: a survey of members from AOSpine International. World Neurosurg. 2014; 81(3-4): 623-33. [11] Mummaneni PV, Kaiser MG, Matz PG, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. J Neurosurg Spine 2009; 11(2): 130-41. [12] Vernon H, Mior S. The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 1991; 14(7): 409-15. [13] Mousavi SJ, Parnianpour M, Montazeri A, et al. Translation and validation study of the Iranian versions of the neck disability index and the neck pain and disability scale. Spine 2007; 32(26): E825-31. [14] Yukawa Y, Kato F, Yoshihara H, Yanase M, Ito K. MR T2 image classification in cervical compression myelopathy: predictor of surgical outcomes. Spine 2007; 32(15): 1675-8. [15] Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc 1958; 166(1): 23-8. [16] Haddadian K, Rezaei O, Sadeghi S, et al. Cervical spondylotic myelopathy: the pattern of neurologic deficits and improvement following anterior cervical decompression. Med J Islam Repub Iran 2005; 18(4): 331-5. [17] Chatley A, Kumar R, Jain VK, Behari S, Sahu RN. Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 2009; 11(5): 562-7. [18] Arvin B, Kalsi-Ryan S, Mercier D, Furlan JC, Massicotte EM, Fehlings MG. Preoperative magnetic resonance imaging is associated with baseline neurological status and can predict postoperative recovery in patients with cervical spondylotic myelopathy. Spine. 2013; 38(14): 1170-6. [19] Tetreault LA, Dettori JR, Wilson JR, et al. Systematic review of magnetic resonance imaging characteristics that affect treatment decision making and predict clinical outcome in patients with cervical spondylotic myelopathy. Spine. 2013; 38(22 Suppl 1):S89-110. [20] Vedantam A, Jonathan A, Rajshekhar V. Association of magnetic resonance imaging signal changes and outcome prediction after surgery for cervical spondylotic myelopathy. J Neurosurg Spine. 2011; 15(6): 660-6. [21] Pumberger M, Froemel D, Aichmair A, et al. Clinical predictors of surgical outcome in cervical spondylotic myelopathy: an analysis of 248 patients. Bone Joint J. 2013; 95-B (7): 966-71. [22] Tetreault LA, Karpova A, Fehlings MG. Predictors of outcome in patients with degenerative cervical spondylotic myelopathy undergoing surgical treatment: results of a systematic review. Eur Spine J. 2015; 24 Suppl 2: 236-51.