Surgery for cervical spondylitic myelopathy offers improvement at 2-years follow-up
Title: Surgery for cervical spondylitic myelopathy offers improvement at 2-years follow-up
Conclusion: "The investigators and members of the AO Spine group should be congratulated on their efforts to collect prospective data on the surgical treatment of cervical spondylitic myelopathy. Of the 278 patients, there were only 70% of the patients available for follow-up at 2 years. The patients were categorized, rather tightly, based on their modified JOA scores. If we look at the group with the severe myelopathy, the follow up there drops to only 61%, so one shortcoming is a lack of good follow up.
In terms of patients who were treated anteriorly, they received anterior decompression and fusion, whereas the posterior strategy included laminectomy, fusion or laminoplasty. The good news is the choice of approach didn’t seem to matter ion terms of benefits to the patient, or the durability of the benefits.
The major shortcoming has to do with the lack of information on the operative approaches. We se from this study that posterior decompression was used in older patients, those with lower mJOA scores and those with greater numbers of diseased segments. However, that doesn’t mean that is the appropriate choice. There are no data that tell us whether the anterior of posterior procedure was truly beneficial in these patients. It is interesting to note that the NSDI scores were lower with the anterior-procedure patients, whether that was due to the number of segments treated or lack of posterior muscle destruction, we will not know.
This work supports the role of decompression for cervical myelopathy, but does little to address the optimal surgical strategy."(My boldface)
– Vincent C. Traynelis, MD
Director, Neurosurgery Spine Service
Vice Chairperson and Professor, Department of Neurosurgery
Rush University Medical Center