title: Resolution of physical signs and recovery in severe cervical spondylotic myelopathy after cervical laminoplasty.
abstract: METHODS
  Retrospective case series review.
  
  
  OBJECTIVE
  To determine the recovery and prevalence of myelopathic signs and their resolution in cervical spondylotic myelopathy after treatment by laminoplasty.
  
  
  BACKGROUND
  Myelopathic signs are an integral component of diagnosis of cervical myelopathy. Effect of surgical intervention (laminoplasty) on recovery of these reflexes has not been studied and remains undetermined. Their recovery and its rate remain unclear. This may be important because resolution may affect recovery, and reappearance may mark relapse.
  
  
  METHODS
  Patients diagnosed as having cervical spondylotic myelopathy based on symptoms, corroborative imaging, and improvement of at least 1 grade in Nurick score were part of study. The patients were evaluated for a period of 1 year from surgery. Hyperreflexia and provocative signs (Hoffman, inverted brachioradialis reflex, clonus, and Babinski) and recovery (Nurick and mJOA) were noted at subsequent follow-up, and improvement was analyzed.
  
  
  RESULTS
  Twenty-one patients had severe spondylotic myelopathy with Nurick score ≥ 3. Myelopathic signs were highly sensitive in diagnosing the presence of severe SCM, because 100% of the SCM patients revealed at least 1 sign on examination. The recovery of these signs was maximum within the first 6 months, with lesser than half of total occurring in immediate and major half in the subsequent 6 months. Beyond this, plateau was seen in recovery, with marginal improvement of these signs. Patients with adverse cord signal changes (t2 hyper/T1 low) had higher prevalence and persistence of individual myelopathic signs compared with patients with only T1 hyperintensity/normal cord in preoperative period and follow-up at the end of 1 year.
  
  
  CONCLUSIONS
  At least 1 myelopathic sign is universal in severe SCM patients. However, individual myelopathic signs cannot alone diagnose disease in all patients. The benefit of laminoplasty is apparent in immediate postoperative period (<7 days), but it is maximum in first 6 months after which the recovery stabilized or these are a marginal improvement. Similarly, the resolution of signs is maximum in period of first 6 months, which parallels recovery. Babinski and inverted brachioradialis reflex revert to normal in most patients and can serve as markers of relapse in long follow-up. Hoffman is not a sensitive test and is likely to persist in patient with severe cord changes.
authors.affiliation: Sir Gangaram Hospital, New Delhi, India. shankaracharya29@gmail.com
authors.forename: Shankar
authors.initials: S
authors.lastname: Acharya
authors.forename: Abhishek
authors.initials: A
authors.lastname: Srivastava
authors.forename: Somesh
authors.initials: S
authors.lastname: Virmani
authors.forename: Rushma
authors.initials: R
authors.lastname: Tandon
mesh_terms: D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013117:Spinal Cord Compression / Q000453:epidemiology* / Q000601:surgery*; D055009:Spondylosis / Q000453:epidemiology* / Q000601:surgery*