Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion.
BACKGROUND
Fifty-one patients with cervical spondylotic myelopathy (CSM) treated by anterior cervical corpectomy with fusion (ACWF) at our institution were included in a study during a period of 10 years to evaluate neurological, anatomical, and functional outcomes including satisfaction levels.


METHODS
We have completed a prospective evaluation of 39 patients with spondylotic myelopathy submitted to ACWF during the period of 1989-2000. The data were analyzed for age, duration of symptoms, severity of preoperative neurological deficit, and single-level or multilevel compressive status looking for possible association with prognostic surrogate data and clinical outcome that were evaluated with the Nurick score and a survey of level of satisfaction.


RESULTS
Of the 51 patients, 39 fullfilled the intended follow-up being 28 men (71.8%) and 11 women (28.2%). The average age was 63.5 years. Duration of symptoms ranged from 1 to 240 months (mean, 38.1 months). The mean preoperative Nurick scale score was 2.97; the mean postoperative score was 2.1. The most frequently involved vertebral body was C5 (71.7%). The follow-up period was longer than 18 months for all patients. Postoperative nonneurological complications occurred in 8 patients (15.6%). The mortality rate was 1.9% (n = 1). Postoperative results showed improvement in 25 patients (64.1%), no change in 13 (33.3%), and worsening in 1 (2.6%). The correlation coefficient of preoperative and postoperative Nurick scores was 0.733 (R(2) = 0.53). Of the 39 patients, 31 answered the questionnaire for quality of life-19 (61.2%) were very satisfied, 6 were satisfied (19.35%), and 6 were not satisfied (19.35%).


CONCLUSIONS
Most patients (80.6%) were very satisfied or satisfied with the outcome and would decide again for the surgery (87%) if the results were previously known. Anterior cervical corpectomy with fusion was a reliable and rewarding procedure for CSM, with functional improvement in most patients. Excellent long-term outcome results in cervical fusion can be achieved without the use of hardware instrumentation.
Chagas
Haroldo
H
Division of Neurosurgery, University Hospital-Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Domingues
Flavio
F
Aversa
Antonio
A
Vidal Fonseca
Ana Luiza
AL
de Souza
Jorge Marcondes
JM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002574:Cervical Vertebrae / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002986:Clinical Trials as Topic; D019299:Decompression, Surgical / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function / Q000502:physiology; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D013128:Spinal Osteophytosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome