Conservative treatment versus surgery in spondylotic cervical myelopathy: a prospective randomised study

A prospective randomised 2-year study was performed to compare the conserva tive and operative treatment of mild and moderate forms of spondylotic cerv ical myelopathy (SCM). Forty-eight patients presenting with the clinical sy ndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) scor e of 12 points or more, were randomised into two groups. Group A, treated c onservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), t imed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on ave rage, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surge ry group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but the re were significant differences in the score of daily activities recorded b y video at 24 months, which was a little lower in the surgical group, and a lso in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was sig nificantly better in the surgical than in conservative group. Surgical trea tment of mild and moderate forms of SCM in the present study design, compri sing the patients with no or very slow, insidious progression and a relativ ely long duration of symptoms, did not show better results than conservativ e treatment over the 2-year follow-up.