FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

UH, MARVIN JESUALDO VARGAS; MOGA, AMADO GONZÁLEZ; BENITEZ, HUGO SANTOS; HERNANDEZ, GABRIEL HUERTA; CARRANZA, JUAN ENRIQUE GUZMÁN

doi:10.1590/S1808-185120171602172279

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Original Article • Coluna/Columna 16 (02) • Apr-Jun 2017 • https://doi.org/10.1590/S1808-185120171602172279 copy

FUNCTIONAL RESULTS OF SURGICAL TREATMENT OF CERVICAL SPONDYLOTIC MYELOPATHY

RESULTADOS FUNCIONAIS DO TRATAMENTO CIRÚRGICO DA MIELOPATIA ESPONDILÓTICA CERVICAL

RESULTADOS FUNCIONALES DEL TRATAMIENTO QUIRÚRGICO DE LA MIELOPATÍA CERVICAL ESPONDILÓTICA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the functional outcome of surgical treatment of cervical spondylotic myelopathy.

Methods:

A retrospective study involving 34 patients with CSM, operated from January 2014 to June 2015. The neurological status was assessed using the Nurick and modified Japanese Orthopedic Association (mJOA) scales preoperatively and at 12 months. Sex, age, time of evolution, affected cervical levels, surgical approach and T2-weighted magnetic resonance hyperintense signal were also evaluated.

Results:

A total of 14 men and 20 women participated. The mean age was 58.12 years. The average progression time was 12.38 months. The preoperative neurological state by mJOA was mild in 2 patients, moderate in 16 and severe in 16, with a mean of 11.44 points. The preoperative Nurick was grade II in 14 patients, grade III in 8, grade IV in 10 and grade V in 2. The T2-weighted hyperintense signal was documented in 18 patients (52.9%). The functional outcome according to the mJOA recovery rate was good in 15 patients (44.1%) and poor in 19 (55.9%). The degree of Nurick recovery was good in 20 (58.8%) and poor in 14 (41.2%).

Conclusions:

Decompressive surgery of the spinal cord has been shown to be effective in the treatment of cervical spondylotic myelopathy in well-selected patients. Although it is suggested that there are certain factors that correlate with functional outcome, we believe that more prospective randomized studies should be conducted to clarify this hypothesis.

Keywords:
Spinal cord compression; Cervical spondylosis; Myelopathy; Decompression surgical.

Statistics
		Age	Months of evolution	Preoperative mJOA score	Postoperative mJOA score at 12 months	mJOA recovery rate
N	Valid	34	34	34	34	34
N	Lost	0	0	0	0	0
Mean		58.12	12.38	11.44	13.38	37.5385
Median		56.00	12.00	12.00	13.5	37.5
Mode		53	10	10^a	16	50.00
Standard Deviation		10.685	3.411	2.501	2.965	23.59280
Variance		114.168	11.637	6.254	8.789	556.62
Range		42	13	11	12	75.00
Minimum		40	6	4	5	0.00
Maximum		82	19	15	17	75.00

Student's t test
		N		Correlation		Sig.
Par 1	Preoperative mJOA score & postoperative mJOA score at 12 months			34		0.933			0.000
Paired tests and samples
		Paired differences				t	gl	Sig. (bilateral)
		Median	Standard Deviation	Mean standard of error	95% confidence interval of the difference
		Median	Standard Deviation	Mean standard of error	Lower	Upper
Par 1	Preoperative mJOA score & postoperative mJOA score at 12 months	-1.941	1.099	0.189	-2.325	-1.558	-10.296	33	0.000

Correlaciones
		Age	Postoperative mJOA score at 12 months
Age	Pearson's correlation	1	-0.509*
	Sig. (bilateral)		0.002
	N	34	34
Postoperative mJOA score at 12 months	Pearson's correlation	-0.509*	1
	Sig. (bilateral)	0.002
	N	34	34

Correlations
		Preoperative mJOA Score	Postoperative mJOA score at 12 months
Preoperative mJOA score	Pearson's correlation	1	0.933**
	Sig. (bilateral)		0.000
	N	34	34
Postoperative mJOA score at 12 months	Correlación de Pearson	0.933**	1
	Sig. (bilateral)	0.000
	N	34	34

Correlations
		Time of evaluation	Postoperative mJOA score at 12 months
Time of evolution	Pearson's correlation	1	0.051
	Sig. (bilateral)		0.774
	N	34	34
Postoperative mJOA score at 12 months	Pearson's correlation	0.051	1
	Sig. (bilateral)	0.774
	N	34	34

Sociedade Brasileira de Coluna Al. Lorena, 1304 cj. 1406/1407, 01424-001 São Paulo, SP, Brasil, Tel.: (55 11) 3088-6616 - São Paulo - SP - Brazil
E-mail: coluna.columna@uol.com.br

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[1] Correspondence: Centro Médico ISSEMyM Ecatepec, Departamento de Cirugía de Columna Vertebral, Avenida del trabajo s/n, Colonia. El Carmen, Estado de México, Mexico. drmarvinvargas@hotmail.com

Cross Table preoperative Nurick grade vs. postoperative Nurick grade at 12 months
Count
		Postoperative Nurick grade at 12 months
		I	II	III	IV	V	Total
Preoperative Nurick grade	II	13	1	0	0	0	14
	III	0	4	4	0	0	8
	IV	0	0	3	6	1	10
	V	0	0	0	0	2	2
Total		13	5	7	6	3	34
Chi squared test
			Value		gl	Asymptomatic signification (bilateral)
Pearson's Chi squared test			69.943^a		12	0.000
Verisimilitude ratio			65.420		12	0.000
Linear-by-linear association			29.617		1	0.000
N of valid cases			34
a. In 19 Boxes (95.0%) a count lower than 5 is expected. The minimum expected count is 18.
Symmetrical measurements
			Value		Approximate signification
Nominal by Nominal		Phi			1.434		0.000
		V de Cramer			0.828		0.000
		Contingency coefficient			0.820		0.000
N of valid cases					34

Cross Table functional Nurick result vs. functional mJOA result.
Count
		mJOA functional result
		Satisfactory		Insufficient	Total
Nurick functional result	Satisfactory		15	5	20
Nurick functional result	Insufficient		0	14	14
Total			15	19	34
Chi squared tests
	Value	gl	Asymptomatic significance (bilateral)	Exact significance (bilateral)	Exact significance (unilateral)
Pearson's Chi squared	18.789^a	1	0.000
Correction of continuity^b	15.871	1	0.000
Verisimilitude ratio	24.169	1	0.000
Fisher's exact test				0.000	0.000
Linear-by-linear association	18.237	1	0.000
N of valid cases	34
a. In 0 Boxes (0.0%), a count of less than 5 is expected. The minimum expected count is 6.18. b. Only calculated for a 2x2 table.
Symmetrical measurements
				Value	Approximate signification
Nominal by Nominal		Phi		0.743	0.000
		V de Cramer		0.743	0.000
		Coefficient of contingency		0.597	0.000
N of valid cases				34

Cross Table hyperintense signal in T2 MRI vs. mJOA functional result
Count
		mJOA functional result
		Satisfactory		Insufficient	Total
Hyperintense signal in T2 MRI		Yes	2	16	18
Hyperintense signal in T2 MRI		No	13	3	16
Total		15		19	34
Chi squared tests
	Value	gl	Asymptomatic signification (bilateral)	Exact signification (bilateral)	Exact signification (unilateral)
Pearson's Chi squared	16.902^a	1	0.000
Correction of continuity^b	14.177	1	0.000
Verisimilitude ratio	18.662	1	0.000
Fisher's exact test				0.000	0.000
Linear-by-linear association	16.405	1	0.000
N of valid cases	34
a. In 0 Boxes (0.0%), a count of less than 5 is expected. The minimum expected count is 6.18. b. Only calculated for a 2x2 table.
Symmetrical measurements
				Value	Approximate signification
Nominal by Nominal	Phi			-0.705	0.000
	Cramer's V			0.705	0.000
	Contingency coefficient			0.576	0.000
N of valid cases				34

Cross table cervical levels affected vs. mJOA functional result
Count
		mJOA functional result
		Satisfactory	Insufficient	Total
Cervical levels affected	1	3	2	5
Cervical levels affected	2	12	8	20
	3 or more	0	9	9
Total		15	19	34
Chi squared tests
		Value	gl	Asymptomatic signification (bilateral)


Pearson's Chi squared		9.663^a	2	0.008
Verisimilitude ratio		6.606	2	0.001
Linear-by-linear association		18.237	1	0.010
N of valid cases		34
a. In 3 Boxes (50.0%) a count of less than 5 is expected. The minimum expected count is 2.21
Symmetrical measurements
				Approximate signification
			Value
Nominal by Nominal		Phi	0.533	0.008
		Cramer's V	0.533	0.008
		Contingency coefficient	0.47	0.008
N of valid cases				34

Cross table preoperative mJOA vs. mJOA functional result
Count
		mJOA functional result
		Satisfactory	Insufficient	Total
Preoperative mJOA	Mild (>15 pts)	2	0	2
	Moderate (12 - 15 pts)	12	4	16
	Severe (<12 pts)	1	15	16
Total		15	19	34
Chi squared tests				34
				Asymptomatic signification (bilateral)

		Value	gl
Pearson's Chi squared		18.029^a	2	0.000
Verisimilitude ratio		21.186	2	0.000
Linear-by-linear association		16.571	1	0.000
N of valid cases		34
a. 2 Boxes (33.3%) a count of less than 5 is expected. The minimum expected count is 88.
Symmetrical measurements
				Approximate signification
			Value
Nominal by Nominal		Phi	0.728	0.000
		Cramer's V	0.728	0.000
		Contingency coefficient	0.589	0.000
N of valid cases			34