Analysis Of Effect And Influencing Factors Of The Surgical Treatment For Cervial Spondylotic Myelopathy

ObjectiveTo observe the surgical outcomes of CSM patients, and to determine the radiographic and clinical factors that correlate with the prognosis. That may be reference for practical clinics. Materials and MethodsThe participants in this study were 46 patients who underwent surgery treatment for CSM in orthopedic department of Xuan Wu Hospital from December 2002 to December 2005. There were 35 men and 11 women, ranging in age from 27 to 75 years, with a mean age of 56 years. The mean postoperative follow-up period was 23 months. Patients with traumatic cervical myelopathy, OPLL,degenerative cervical instability,coexistence of cervical and lumbar disc disease were not included in this study.(1) We divided cases into two groups according to pre-surgery MR images: ISI group and no ISI group. Surgical outcomes were compared between the two groups.(2) The following parameters were obtained: age at the time of surgery, duration of symptoms, compression segment of cervical spinal cord, preoperative JOA score, preoperative transverse areas of the spinal cord at the site of maximal compression on T2-weighted sequences, ratio between the preoperative transverse areas of the spinal cord and the preoperative transverse areas of the vertebral canal at the site of maximal compression on T2-weighted sequences. Correlations among the recovery rate and the six aforementioned parameters were investigated.(3) The most useful combination of parameters for predicting prognosis was determined using a stepwise regression analysis.Take Data were analyzed with SPSS for Windows 11.5. Took p-value less than 0.05 as the positive criteria.ResultsStatistical analysis of the cases revealed that the mean pre-operative JOA scores were 9.74±2.46 and the postoperative JOA scores were 12.80±2.14,(P<0.01). The mean postoperative recovery rate was (42.93±19.17)%.(1) There was no significant difference of the recovery rate between group ISI and group no ISI.(2) Significant relations were noted between the recovery rate and the age at the time of surgery, preoperative transverse areas of the spinal cord at the site of maximal compression and the ratio between the preoperative transverse areas of the spinal cord and the preoperative transverse areas of the vertebral canal at the site of maximal compression.(3) Stepwise regression analysis showed that the best combination of surgical outcome predictors included age at the time of surgery and the ratio between the preoperative transverse areas of the spinal cord and the preoperative transverse areas of the vertebral canal at the site of maximal compression. The multiregression equations are as follows: recovery rate = 0.625-0.008(age at the time of surgery) +1.146(ratio between the preoperative transverse areas of the spinal cord and the vertebral canal at the site of maximal compression), (P<0.01,R Square=0.375). ConclusionsOur study demonstrates that the predictors of surgical outcomes are the age at the time of surgery, the preoperative transverse areas of the spinal cord at the site of maximal compression on T2-weighted sequences and the ratio between the preoperative transverse areas of the spinal cord and the preoperative transverse areas of the vertebral canal at the site of maximal compression. The preoperative ISI,duration of symptoms, compression segment of cervical spinal cord, preoperative JOA score can not predict the prognosis.