Preliminary Study On Natural Course And Surgical Outcome Of Multilevel Cervical Spondylotic Myelopathy

[Backgrounds]Cervical spondylotic myelopathy (CSM) remains the most prevalent disease process thatcauses spinal cord injury in older patients. So far,there are two kinds of views about thenatural history of CSM. Most of the scholars think that this disease is generallycharacterized by an unrelenting and progressively worsening course, surgical interventionremains the most predictable and reliable way to halt further neurologic deterioration. Afew scholars think that the majority of the patients had long periods of stable symptoms,CSM may manifest as a slow, stepwise decline or there may be a long period of quiescence.Further study on natural history of CSM is helpful for early diagnosis and surgicalintervention. The pathology of CSM has several stages, degeneration of intervertebral disc,herniation of nucleus pulposus, intervertebral height lost, instability, and spinal cordventral compression caused by osteophyte formation in the posterior of vertebrae. Inaddition, intervertebral height lost results in the change of ligamentum flavum, such asrelaxation, hyperplasia and hypertrophy, or fold into vertebra canal led to both ventral anddorsal compression, to reduce compensatory space of spinal cord. In clinic,we can findpatients whose routine MRI showed anterior compression of spinal cord or patients withpinching cervical spondylotic myelopathy. According to pathophysiology, can wedetermine whether the former is the natural development process of pinching compression?Pinching CSM is characterized by longer duration of symptoms and serious condition,surgical treatment is required as soon as possible. There are still many controversial abouthow to perform surgery.By ACDF, we can not only removal the oppression in front ofcervical spinal cord,bu also relieve oppression from rear. It has considerablesignificance.for spine surgeon to analysis the outcome of ACDF and predictors ofsurgical outcome in pinching cervical spondylotic myelopathy.[Objectives]1.To study the natural disease process of CSM and explore the relationship between thedisease progress tendency and the imaging changes.To find out the evidence that the"wavy" compression transform to the “pinching” compression through the cervical MRI.2.To analysis the clinical features of patients with pinching cervical spondylosismyelopathy and vertify the relationship between “wavy” compression and “pinching”compression.3. To investigate the efficacy and possibly predictors of ACDF. [Methods]1.41patients with MRI examination at least two times were analyzed.We recorded thenatural course of disease,basci clinical data, chief clinical symptoms and so on.Wemeasured occupying rate, anterior occupying rate, posterior occupying rate, intervertebralspace height, cervical alignment. the probability high signal of spinal cord. To find out therelationship between the changes of clinical symptoms and imaging changes.2.46patients whose routine MRI showed anterior compression of spinal cord or67patients with pinching cervical spondylosis myelopathy were analyzed.We find out thedifferences in age gender the duration of symptoms levels involved preexisting medicalcomorbidities JOA the probability high signal of spinal cord the probability high signalof spinal cord.what is more，to analysis of the relevant factors that affect POR.3.A retrospective review was performed on62pinching CSM to investigate the effect ofACDF and the correlation factors influencing the paognosis.The assessment tools includeJOA NDI VAS GRT30m-walking test and perioperative events.[Results]1.Twenty four patients with CSM developed slowly,15patients had different degrees ofdeterioration,2patients’s symptoms alleviated spontaneously,9patients with canalcompression rate increase in cervical spine MRI, showed "wavy" compression pattern.2.To compared with the “pinching” compression patients, the patients with "wavy"compression pattern are older, have longer disease duration of symptoms, lower functionof sensory nerve function score, faster deterioration within1year. However, gender, thenumber of the involved segment, Comorbidities, intramedullary high signal probability,movement function score were not different significantly between the two groups.Thedegree of oppression behind spinal cord is associated with aligment of cervical discheight age and OR.3. The parameters including JOA VAS GRT30-m-walkingtest NDI were significantly improvedafter ACDF The recovery rate was relatedwith age，baseline JOA improvement rate ofROM and POR.Conclusions]1.The majority of the CSM may manifest as a slow, stepwise decline or there may be along period of quiescence.Few patients had different degrees of deterioration at any stage.Very few patients’s symptoms alleviated spontaneously. The slow process of imagingchanges are also long-term progress. The anterior compression of the spinal cord occurred earlier than posterior’s.2.“Pinching” compression is the outcome of the "wavy" compression Combination ofanterior compression of the spinal cord and posterior’s accelerated the progress of thedisease.3.ACDF is an effective method for the treatment of pinching CSM.Younger age Modulating postoperative ROM, smaller POR and higher beseline JOA may inproveimprove neurological recovery in selected patient.