Neurospine.  2019 Sep;16(3):435-447. 10.14245/ns.1938196.098.

Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

  • 1Department of Neurosurgery, Ege University, Izmir, Turkey.
  • 2Department of Neurosurgery, LTMG Hospital & LTM Medical College, Mumbai, India.
  • 3Department of Neurosurgery, AIIMS, New Delhi, India.
  • 4Amrita Institute of Medical Sciences, Kochi, India.
  • 5Department Neurosurgery and Spine Unit, Kovai Medical Center and Hospital, Tamilnadu, India.


This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.


Cervical spondylotic myelopathy; Outcome measures; Clinical variables; Radiologic variables; Surgical outcome; Magnetic resonance imaging

MeSH Terms

Asian Continental Ancestry Group
Magnetic Resonance Imaging
Muscle Spasticity
Outcome Assessment (Health Care)*
Spinal Cord Compression
Spinal Cord Diseases*
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