Relationships between outcomes of conservative treatment and magnetic resonance imaging findings in patients with mild cervical myelopathy caused by soft disc herniations

Study Design. A retrospective follow-up study of conservatively treated pat ients with mild cervical myelopathy caused by cervical soft disc herniation . Objective. To investigate the outcome of conservative treatment for patient s with mild myelopathy caused by cervical soft disc herniation and to evalu ate usefulness of magnetic resonance findings in the prediction of the outc omes. Summary of Background Data. Recent studies on conservative treatment for ce rvical soft disc herniation have focused mainly on radiculopathy, and not o n myelopathy. Methods. Twenty-seven patients with mild cervical myelopathy secondary to c ervical soft disc herniation were treated conservatively for more than 6 mo nths by cervical bracing and restriction of daily activities. Of the 27 pat ients, 17 patients (Group A) underwent conservative treatment only and it w as associated with improvement in their neurologic deficits, while the othe r 10 patients (Group B) ultimately underwent decompression surgery because of neurologic deterioration. Comparisons between the two groups were made i n regard to JOA scares, patient satisfaction, and magnetic resonance findin gs, including location of the disc herniation (focal or diffuse in the sagi ttal plane, median or paramedian in the axil plane). Results. The JOA scores were 13.6 +/- 1.6 in Group A and: 14.1 +/- 1.6 in G roup B before treatment, 14.9 +/- 1.0 and 12.9 +/- 2.1, respectively, at 3 months, and 16.2 +/- 0.8 and 16.0 +/- 1.2, respectively, at the final follo w-up. The JOA scores at 3 months were significantly lower in Group B than i n Group A. Satisfaction with the results of treatment at the final follow-u p was reported by 77% of the patients in Group A and 90% in Group B. Focal- type herniation was present in 47% of the patients in Group A and 70% in Gr oup B, while median-type herniation was diagnosed in 77% in Group-A and 30% in Group B Follow-up magnetic resonance imaging of the patients in Group A showed spontaneous regression of a herniated mass in 10 patients (59%). Di ffuse-type herniations were more likely to regress spontaneously than focal -type herniations (78% vs. 37%). Conclusions. Conservative treatment is an effective treatment option for mi ld cervical myelopathy caused by cervical soft disc herniation. A goad outc ome can be expected in patients with a median-type and/or diffuse-type hern iation on magnetic resonance imaging.