title: A modern multidisciplinary approach to patients suffering from cervical spondylotic myelopathy.
abstract: BACKGROUND
  The traditional approach to patients suffering from cervical spondylotic myelopathy (CSM) consists of mere assessment of radiological standard magnetic resonance (MR) images and evaluation of surgical indication, depending on clinical symptoms and degree of radiological stenosis. Identification of prognostic factors for surgery remains difficult. Surgery is thought to be able to stop the disease progression, while significant improvements of neurological symptoms are not predictable.
  
  
  METHODS
  Authors present a modern approach to patients with CSM, that is comprehensive of clinical, electrophysiological and radiological findings, and that has been developed by a multidisciplinary team of experts (neurosurgeons, neurologists, neuroradiologists). Authors tried to identify the good responders to surgery, as those who really improved symptoms, by performing an integration of these data. This approach has been used in 11 consecutive patients suffering from and operated for CSM at our Institution. The multidisciplinary protocol included the complementary use of electrophysiological (motor and somatosensory evoked potentials), radiological (magnetic resonance, cervical plain and dynamic x-rays), and clinical (modified Japanese Orthopedic Association [mJOA] and Neck Disability Index [NDI] scores, Hirabayashi Recovery Ratio) values. These data were obtained at the preoperative period, and at 3 and 12 months follow-up. We defined as "good responders" those patients having had an improvement of the Hirabayashi Recovery Ratio of 50% and of the NDI of 30%.
  
  
  RESULTS
  The mean preoperative mJOA was 12.79 (range 3-17), while the mean mJOA at 3 and 12 months was, respectively, 14.71 and 13.43. However, only the improvement at 3 months was statistically significant, while improvements from the preoperative assessment to 12 months and from 3 to 12 months were not significant. The mean preoperative NDI was 33.57%, while it was 32.43% and 24.36% at 3 and 12 months, respectively. None of these improvements was significant. Concerning response to surgery, we observed 7/11 (63.3%) good responders according to the Hirabayashi Recovery Ratio, and 6/11 (54.5%) good responders according to NDI results.
  
  
  CONCLUSIONS
  A modern multidisciplinary approach to patients with CSM is mandatory to investigate the different aspects of the disease. Decompressive surgery was able, in our series, to improve or stabilize clinical symptoms. Further studies are necessary to allow for a proper selection of patients by cumulative analysis of multidisciplinary findings.
authors.affiliation: Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland - tessenri@libero.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Tessitore
authors.affiliation: Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Broc
authors.affiliation: Neurological Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Abdelhafid
authors.initials: A
authors.lastname: Mekideche
authors.affiliation: Neurological Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Margitta
authors.initials: M
authors.lastname: Seeck
authors.affiliation: Neurological Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: André
authors.initials: A
authors.lastname: Truffert
authors.affiliation: Diagnostic Neuroradiology Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Maria I
authors.initials: MI
authors.lastname: Vargas
authors.affiliation: Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Claudio
authors.initials: C
authors.lastname: Schonauer
authors.affiliation: Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, Medical School, University of Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D019299:Decompression, Surgical / Q000379:methods*; D056324:Diffusion Tensor Imaging; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D019637:Orthopedic Procedures / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000601:surgery*; D055009:Spondylosis / Q000175:diagnosis* / Q000601:surgery*