Introduction: Cervical Spondylotic Myelopathy (CSM) occurs more than any other cervical disease in the elderly. The modified Japanese Orthopaedic Association scale (mJOA) grades patient symptom severity on a total scale of 0-18 and is considered an efficient means of patient evaluation. Presently, few studies have specifically examined the surgical management of CSM patients with severe myelopathy. The purpose of this study was to measure the effect of surgery on patients with a mJOA score indicating severe disease.
Methods: We utilized data from two prospective CSM cohort studies to investigate surgical benefit for patients with severe CSM. All patients had symptomatic CSM and subsequently underwent surgical decompression. Each patient completed visits at baseline as well as 6, 12, and 24 months following surgery. Paired t-tests were used to assess the differences between preoperative and postoperative scores.
Results: Sixty-seven patients with a mJOA score of 8 or less were identified in the combined cohort. The mean age was 63.0 ± 12.22, and 61.2% of the patients were male. The average mJOA score was 6.85. Mean improvement in mJOA score following surgery was 5.51, 6.07, and 6.15 at six-months, one-year, and two-years following surgery, respectively (p < .0001). When compared to other groups of patients stratified by mJOA score, patients with severe CSM (mJOA of 8 and below) showed more improvement in the mJOA, Nurick scale (-2.05), Neck Disability Index (-20.49), and Physical Component summary score of the SF-36 (9.42) at one year follow-up. These changes were all statistically significant (p <.0001).
Conclusions: Patients with severe CSM, defined in this study as a mJOA score of 8 or less, receive the most benefit from surgery when compared to other patients with CSM. In this population, surgery can offer significant and sustained improvements in quality of life.
Patient Care: This research demonstrates the efficacy of surgical management for patients with severe CSM by describing results from two large clinical cohort trials. Clinicians caring for patients with severe CSM will have additional information to inform treatment decisions.
Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe various scales used to quantify the severity of CSM and 2) Discuss the possible benefits of surgical management for patients with severe CSM