Outcome of patients treated for cervical myelopathy - A prospective, multicenter study with independent clinical review

Study Design. This Cervical Spine Research Society (CSRS) Study is a prospe ctive, multicenter, nonrandomized investigation of patients with cervical s pondylosis and disc disease. In this analysis, only patients with cervical myelopathy as the predominant syndrome were considered. Objectives. To determine demographics, surgeon treatment practices, and out comes in patients with symptomatic myelopathy. Summary of Background Data. Current data on patient demographics and treatm ent practices of surgeons do not exist. There are no published prospective studies in which neurologic, functional, pain, and activities of daily livi ng outcomes are systematically quantified. Methods. Patients were recruited by participating CSRS surgeons. Demographi c information, patients' symptoms, and patients' functional data were compi led from patient and physician surveys completed at the time of initial exa mination, and outcomes were assessed from patient surveys completed after t reatment. Data were compiled and statistically analyzed by a blinded third party. Results. Sixty-two (12%) of the 503 patients enrolled by 41 CSRS surgeons h ad myelopathy. Patients (48.4% male; mean age, 48.7 +/- 12.03 years) had a mean duration of symptoms of 29.8 months (range, 8 weeks to 180 months). Su rgery was recommended for 31 (50%) of these patients. Forty-three patients (69%) returned for follow-up and completed the questionnaire adequately for analysis. Twenty (46%) of the 43 patients on whom follow-up data are avail able underwent surgery, and 23 (54%) received medical treatment. Surgically treated patients had a significant improvement in functional status and ov erall pain, with improvement also observed in neurologic symptoms. Patients treated nonsurgically had a significant worsening of their ability to perf orm activities of daily living, with worsening of neurologic symptoms. Conclusions. When medical and surgical treatments are compared, surgically treated patients appear to have better outcomes, despite exhibiting a great er number of neurologic and nonneurologic symptoms and having greater funct ional disability before treatment. Randomized studies, if feasible, should be performed to address outcome in cervical myelopathy further.