Research Of The Surgical Outcome And Influencing Factors For Cervical Spondylotic Myelopathy

Objective:To explore the effectiveness of surgical treatment for cervical spondylotic myelopathy.To observe the relationship between surgical curative outcome and patients' gender,age,duration of the disease,preoperative neurological situation,ossification of posterior longitudinal ligament,severity of canol stenosis,duration of operation and specific performance on magnetic resonance imaging.To provide valuable reference for the appropriate opportunity of surgical treatment and preoperative prediction of cervical spondylotic myelopathy.Methods:Seventy-one patients,who were treated between January 2016 and December 2017 in the Second People General Hospital of Guangdong Province and Zhujiang Hospital of Southern Medical University because of cervical spondylotic myelopathy,have been carried out retrospective cohort study.Their statistical indicators such as gender,age,course of the disease,preoperative MRI and CT imaging performance have been collected,They were postoperatively follow-up visit for 12 to 24 months to collect the data about the functional recovery after operation.SPSS 21.0 statistical software was used for statistical analysis.The heterogeneity test of pre-and postoperative JOA score and also the correlation analysis between the recovery ratio of the improved JOA score(RIS)and the factors which may affect the prognosis were conducted.Results:The increase of JOA score from 10.56±2.234pre-operation to 15.14±1.966post operation in all the 71 patients with cervical spondylotic myelopathy was statistically significant(p<0.001).The average value of RIS is71.73±25.72%.Assessment of RIS:38 cases of excellent,22 cases of good,7 cases of medium and 4 cases of poor.The rate of excellent and good is 84.5%For the anterior approach,the average JOA score was 10.90±2.03 pre-operation,and 15.31±1.70post operation,as the RIS is72.81±24.21%,and the rate of excellent and good is 85.48%.For the posterior approach,the average JOA score is 8.22±2.27 pre-operation and 14.00±3.16 post operation as the RIS is 64.28±35.29%and the rate of excellent and good is 77.78%There was a statistically significant correlation between RIS and patients' gender(p=0.028),age(p=0.039)and operation duration(p=0.024).The correlation between surgical efficacy and course of disease,preoperative JOA score,whether or not the ossification of posterior longitudinal ligament,the degree of spinal cord compression on imaging,and Nurick type of the increased signal intensity on MR T2WI was not statistically significantly supported.Conclusions:?The curative effect of surgical treatment on cervical spondylotic myelopathy is certain.?Male and elderly are two factors which predict a poor prognosis.?Long operation time is a risky factor for poor surgical efficacy.?There was no statistically significant correlation between the surgical prognosis and preoperative course,preoperative JOA score,whether or not the ossification of posterior longitudinal ligament,the severe situation of spinal cord compression on imaging,Nurick type of the increased signal intensity on MR T2W imaging.The judgment of surgical prognosis should not only rely on the positive findings on imaging,but should be combined with the actual situation of the patient.