Neurological Recovery Pattern in Cervical Spondylotic Myelopathy after Anterior Surgery: A Prospective Study with Literature Review

Pandita, Naveen; Gupta, Sanjeev; Raina, Prince; Srivastava, Abhishek; Hakak, Aamir Yaqoob; Singh, Omeshwar; Darokhan, Mohd Azhar ud din; Butt, Mohd Farooq

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 of myelopathy symptoms is an important factor that determines the outcomes of surgical decompression. The present findings contribute to the literature on the pattern of neurological recovery and patient prognosis with respect to the resolution of myelopathy symptoms after surgery.
METHODS
This prospective study was conducted in Government Medical College in Jammu, North India between November 2012 and October 2014, a total of 30 consecutive patients with CSM were included and treated with anterior decompression and stabilization. They were prospectively followed up for 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 before 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 of 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 of 0%-50%. The average recovery rate during the 4th month was 32.5%, with a range of 0%-60%, while that during the 6th month was 72.83%, with a range of 0%-100%. The average recovery rate during the final follow-up of 1 year was 54.3%.
CONCLUSIONS
Neurological recovery after surgical decompression starts from the 3rd postoperative month and progresses until the 6th postoperative month; thereafter, it gradually plateaus over the subsequent 6 months until it steadies. Symptom duration is an important factor that requires consideration while determining postoperative neurological recovery.