Postoperative prognosis of Brown-Sequard-type myelopathy in patients with cervical lesions

BACKGROUND Postoperative prognosis of the hemihypalgesia in patients with B rown-Sequard-type myelopathy (BSM) caused by cervical lesions is of great i nterest to surgeons. However, there are very few reports discussing the pos toperative prognosis of BSM. METHODS We evaluated the prognosis of BSM using the criteria of the Japanes e Orthopaedic Association (JOA) score in 16 (seven ossification of the post erior longitudinal ligament [OPLL], 5 cervical spondylosis [CS], and 4 disc herniation patients) out of 233 surgically treated patients with cervical diseases. The mean follow-up duration was 2 years and 11 months. RESULTS After surgery, none of these patients showed complete resolution of hemihypalgesia, although the most rostral level of hemihypalgesia moved in a caudal direction in 13 patients (81%), whose recovery ratios of JOA scor e were significantly better than those of hemihypalgesia-level-persisted pa tients. In our BSM series, OPLL occurred most frequently and the anterior e lement compressing the spinal cord existed most frequently in the central a rea of the vertebra (44%). Postoperative improvement in the motor function of the legs in the disc herniation group was significantly better than in t he OPLL and CS groups (p < 0.05, respectively). There were no significant d ifferences in the functional prognosis between the BSM and non-BSM patient groups. CONCLUSIONS BSM patients can expect almost the same functional outcome as n on-BSM patients, with the exception of the disappearance of hemihypalgesia. (C) 1999 by Elsevier Science Inc.