Neurological recovery pattern in cervical spondylotic myelopathy after anterior surgery: A prospective study with literature review

Abstract

Study Design: Prospective clinical study. Purpose: The present study aimed to examine the neurological recovery pattern in cervical spondylotic myelopathy (CSM) after anterior cervical decompression and compare it with the existing reports in the literature. Overview of Literature: Neurological recovery and regression off myelopathy symptoms is an important ffactor that determines the outcomes off surgical decompression. The present findings contribute to the literature on the pattern off neurological recovery and patient prognosis with respect to the resolution off myelopathy symptoms affter surgery. Methods: This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total off 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively ffollowed up ffor 1 year and were evaluated for their neurological recovery pattern. The postoperative outcome was evaluated using the modified Japanese Orthopaedic Association (mJOA) score. The recovery rate was calculated using Hirabayashi's method. The JOA score was assessed beffore the operation and postoperatively at 1 week, 2 weeks, 1 month, 3 months, 4 months, 6 months, and 1 year. Results: The postoperative mJOA score was 0 in the 1st month, 12.90±3.57 in the 3rd month, 13.50±3.55 in the 4th month, 14.63±3.62 in the 6th month, and 14.9±3.24 at the final follow-up off 1 year. The average recovery rate during the 1st month follow up was 0%, and that during the 3rd month follow up was 12.91% with a range off 0%-50%. The average recovery rate during the 4th month was 32.5%, with a range off 0%-60%, while that during the 6th month was 72.83%, with a range off 0%-100%. The average recovery rate during the final ffollow--up off 1 year was 54.3%. Conclusions: Neurological recovery affter surgical decompression starts ffrom the 3rd postoperative month and progresses until the 6th postoperative month; thereaffter, it gradually plateaus over the subsequent 6 months until it steadies. SSymptom duration is an important ffactor that requires consideration while determining postoperative neurological recovery.