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JOURNAL OF NEUROSURGICAL SCIENCES
A Journal on Neurosurgery
Indexed/Abstracted in: e-psyche, EMBASE, PubMed/MEDLINE, Neuroscience Citation Index, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,651
Journal of Neurosurgical Sciences 2016 May 13
A modern multidisciplinary approach to patients suffering from cervical spondylotic myelopathy
Enrico TESSITORE 1, Nicolas BROC 1, Abdelhafid MEKIDECHE 2, Margitta SEECK 2, André TRUFFERT 2, Maria I. VARGAS 3, Claudio SCHONAUER 1, Karl SCHALLER 1
1 Neurosurgical Unit, Geneva University Hospitals, Faculty of Medicine, University School of Medicine, Geneva, Switzerland; 2 Neurological Unit, Geneva University Hospitals, Faculty of Medicine, University School of Medicine Geneva, Switzerland; 3 Diagnostic Neuroradiology Unit, Geneva University Hospitals, Faculty of Medicine, University School of Medicine Geneva, Switzerland
BACKGROUND: The traditional approach to patients suffering from cervical spondylotic myelopathy (CSM) consists of mere assessment of radiological standard 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 N=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 (mJOA and NDI scores, Hirabayashi 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 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 between the preoperative and 12 months and between 3 and 12 months were not significant. The mean preoperative NDI was 33.57%, while it was respectively 32.43% and 24.36% at 3 and 12 months. None of these improvements was significant. Concerning response to surgery, we observed 7/11 (63.3%) good responders according to the Hirabayashi 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.