Early neurological recovery course after surgical treatment of cervical spondylotic myelopathy: a prospective study with 2-year follow-up using three different functional assessment tests

Abstract

Purpose: Though surgical decompression is today a common option for treatment of cervical spondylotic myelopathy (CSM), little is known about the exact postoperative early neurological recovery course. The purpose of this study was to analyze the functional recovery, its dynamics, its intensity and its pattern, in the early postoperative period after surgical decompression for CSM. Methods: A prospective non-controlled observational study was performed from March 2006 to July 2008, and included consecutive patients with CSM who underwent surgical decompression. Functional assessments were done before the operation, at 1 month, 6, 12, 18 and 24 months after surgery using three tests: the Japanese Orthopaedic Association (JOA) test, the nine-hole peg test (9HPT) and the Crockard walking test. Results: Sixty-seven patients were included (mean age of 61 years). The global JOA score improved after surgery, reaching statistical significance at 1 month (from 11.5 ± 2.6 to 13.6 ± 2.0 points, p = 0.0078), then settling to a plateau till the end of follow-up at 24 months (12.7 ± 2.6 points). The 9HPT and the Crockard test did not show any significant improvement after surgery. Conclusions: Neurological recovery after surgical decompression has been proved to be very fast during the first month, but stabilizes afterwards. The JOA score is the best assessment to reveal neurological improvement in the early recovery course.