Background. Cervical spondylosis can cause three different categories of symptoms and signs with possible overlap in the affected patients. Aim. We aim to compare functional outcome of surgery in the patients with cervical spondylotic radiculopathy and myelopathy, regardless of their surgical type and approach. Materials and Methods. We retrospectively reviewed 140 patients with cervical spondylotic radiculopathy and myelopathy who had been operated from August 2006 to January 2011, as Group A (68 cases) and Group B (72 cases), respectively. The mean age was 48.2 and 55.7 years, while the mean followup was 38.9 and 37.3 months, respectively. Functional outcome of the patients was assessed by neck disability index (NDI) and patient satisfaction with surgery. Results. Only in Group A, the longer delay caused a worse surgical outcome (NDI). In addition, in Group B, there was no significant relationship between imaging signal change of the spinal cord and our surgical outcomes. Improvement in NDI and final satisfaction rate in both groups are comparable. Conclusions. Surgery was associated with an improvement in NDI in both groups ( ). The functional results in both groups were similar and comparable, regarding this index and patient's satisfaction score. 1. Introduction Spondylosis is the most common cause of neural compression in cervical spine [1]. The disease can cause three different categories of symptoms and signs with possible overlap in the affected patients [2, 3]. These patients may complain of the neck (pain, stiffness, and limited range of motion) or suffer from radiculopathy or even myelopathy [4]. Neurologic symptoms are usually aroused when the space available for the neural elements is reduced by osteophytes, hypertrophied ligamentum flavum, or a herniated disc [4]. In those patients whose main manifestation of the disease is neck complains, conservative treatment is usually recommended, while in some with cervical spondylotic radiculopathy (CSR) or myelopathy (CSM), surgery may be associated with better satisfactory outcomes [5–7]. Although, some authors still have doubts about the long-term results of surgery in these cases [2, 8]. The poor prognostic factors usually quoted in the surgical treatment of the patients include older age, abnormal cervical curvature, multisegmental compression, more duration of symptoms, higher number of comorbidities, decreased signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and existence of cord atrophy in preoperative magnetic resonance images (MRIs) [1, 5, 6,
References
[1]
M. Ishii, E. Wada, and M. Hamada, “Deterioration of surgical outcomes with aging in patients with cervical spondylotic myelopathy,” Journal of Spinal Disorders and Techniques, vol. 25, no. 7, pp. E199–E203, 2012.
[2]
I. Nikolaidis, I. P. Fouyas, P. A. Sandercock, and P. F. Statham, “Surgery for cervical radiculopathy or myelopathy,” Cochrane Database of Systematic Reviews, no. 1, Article ID CD001466, 2010.
[3]
A. Petkov, T. Eftimov, I. Hadzhiangelov, and I. Ivanov, “Surgical treatment in cervical spondylosis,” Khirurgiia, no. 3, pp. 36–40, 2008.
[4]
R. D. Rao, B. L. Currier, T. J. Albert et al., “Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management,” Journal of Bone and Joint Surgery A, vol. 89, no. 6, pp. 1360–1378, 2007.
[5]
P. Sampath, M. Bendebba, J. D. Davis, and T. B. Ducker, “Outcome of patients treated for cervical myelopathy: a prospective, multicenter study with independent clinical review,” Spine, vol. 25, no. 6, pp. 670–676, 2000.
[6]
R. D. Rao, K. Gourab, and K. S. David, “Operative treatment of cervical spondylotic myelopathy,” Journal of Bone and Joint Surgery A, vol. 88, no. 7, pp. 1619–1640, 2006.
[7]
S. Kadoya, H. Iizuka, and T. Nakamura, “Long-term outcome for surgically treated cervical spondylotic radiculopathy and myelopathy,” Neurologia Medico-Chirurgica, vol. 43, no. 5, pp. 228–241, 2003.
[8]
I. P. Fouyas, P. F. Statham, P. A. Sandercock, and C. Lynch, “Surgery for cervical radiculomyelopathy,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD001466, 2001.
[9]
M. G. Fehlings and B. Arvin, “Surgical management of cervical degenerative disease: the evidence related to indications, impact, and outcome,” Journal of Neurosurgery, vol. 11, no. 2, pp. 97–100, 2009.
[10]
A. Chatley, R. Kumar, V. K. Jain, S. Behari, and R. N. Sahu, “Effect of spinal cord signal intensity changes on clinical outcome after surgery for cervical spondylotic myelopathy,” Journal of Neurosurgery, vol. 11, no. 5, pp. 562–567, 2009.
[11]
J. Lemcke, H. Menz, F. Al-Zain, and U. Meier, “Outcome after anterior cervical discectomy and arthrodesis: a clinical study of 368 patients,” Neurosurgery Quarterly, vol. 19, no. 3, pp. 164–170, 2009.
[12]
H. Vernon and S. Mior, “The neck disability index: a study of reliability and validity,” Journal of Manipulative and Physiological Therapeutics, vol. 14, pp. 409–415, 1991.
[13]
S. J. Mousavi, M. Parnianpour, A. Montazeri et al., “Translation and validation study of the Iranian versions of the neck disability index and the neck pain and disability scale,” Spine, vol. 32, no. 26, pp. E825–E831, 2007.
[14]
E. G. Wood III and E. N. Hanley Jr., “Lumbar disc herniation and open limited discectomy: indications, techniques, and results,” Operative Techniques in Orthopaedics, vol. 1, no. 1, pp. 23–28, 1991.
[15]
K. Yonenobu, “Cervical radiculopathy and myelopathy: when and what can surgery contribute to treatment?” European Spine Journal, vol. 9, no. 1, pp. 1–7, 2000.
[16]
B. M. McCormack and P. R. Weinstein, “Cervical spondylosis. An update,” Western Journal of Medicine, vol. 165, no. 1-2, pp. 43–51, 1996.
[17]
J. C. Furlan, S. Kalsi-Ryan, A. Kailaya-Vasan, E. M. Massicotte, and M. G. Fehlings, “Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases,” Journal of Neurosurgery, vol. 14, no. 3, pp. 348–355, 2011.
[18]
D. Radulovi？, S. Ivanovi？, M. Jokovi？, and G. Tasi？, “The results of surgical treatment for cervical spondylotic myelopathy,” Acta Chirurgica Lugoslavica, vol. 52, no. 1, pp. 91–95, 2005.
[19]
A. Karpova, R. Arun, A. M. Davis et al., “Predictors of surgical outcome in cervical spondylotic myelopathy,” Spine, vol. 38, no. 5, pp. 392–400, 2013.
[20]
S. Naderi, S. ？zgen, M. N. Pamir, M. M. ？zek, and C. Erzen, “Cervical spondylotic myelopathy: surgical results and factors affecting prognosis,” Neurosurgery, vol. 43, no. 1, pp. 43–49, 1998.
[21]
P. V. Mummaneni, M. G. Kaiser, P. G. Matz et al., “Cervical surgical techniques for the treatment of cervical spondylotic myelopathy,” Journal of Neurosurgery, vol. 11, no. 2, pp. 130–141, 2009.
[22]
L. Gebremariam, B. W. Koes, W. C. Peul, and B. M. Huisstede, “Evaluation of treatment effectiveness for the herniated cervical disc: a systematic review,” Spine, vol. 37, no. 2, pp. E109–E118, 2012.
[23]
K.-J. Song, G.-H. Kim, B.-W. Choi, and K.-B. Lee, “Does plate construct improve the result of 1- or 2-level anterior cervical fusion?” Neurosurgery Quarterly, vol. 18, no. 3, pp. 172–177, 2008.
