Quantitative evaluation and grading of neurological recovery after Anterior Cervical Surgery for Single or Double Level cervical Spondylotic Myelopathy

Abstract

Background: Cervical Spondylotic Myelopathy (CSM) is a common cause of spinal cord dysfunction it may lead to function disability as well as neurological deterioration. Surgical decompression is essential in progressive disease. Postsurgical neurological recovery assessment is essential. Most of these methods of assessment is either subjective or numerical values at a time. It is important to quantify these outcome and grade it into a scale for better understanding. Materials and Methods: 48 patients with single or double level CSM underwent anterior cervical discectomy and fusion (ACDF) or anterior cervical corpectomy and fusion at our institute from January 2017- 2019. Data analyzed for age, sex, duration of follow-up, operative time, blood loss and complication. Moderate and severe grade myelopathy considered surgical candidates. 31 patients had moderate (mjoa,12-14) and 14 patients had severe (mJOA ,11 and less) myelopathy. Metallic spacer for ACDF and titanium mesh cage (TMC) for ACCF with Morcellised local auto graft and all cases supplemented with variable angle cervical plates. MJOA scores and Hirabayashi recovery rate calculated at 1st month, 3rd month, 6th month and 12th month post-operatively. Results: Out of 48 patients, we had final follow-up of 45 patients. Mean age of our study 58.53±6.61 years (range 35- 73 years) Mean duration of follow-up 19.71±5.29 months (13 – 34 Months). Mean operative time and mean blood loss was more in single level ACCF cases as compare to single ACDF cases. C5-C6 ACDF and C5 Corpectomy were most performed surgeries in our study. Our all patient has shown neurological recovery from some to complete extent at final follow-up of 12 months. All moderate grade patient improved to mild grade or normal neurology and all severe grade patients improved to either moderate or mild grade .We have observed 100 % improvement in mJOA grade after anterior cervical surgery. At 12 months follow-up, 12 patients had normal (18) mJOA Score, 30 mild (mJOA, 15-17) grade and 3 moderate grade. At final follow-up 93.3% patients had shown excellent to good recovery rate(29/ 45 excellent , 13/45 good whereas 3/45( 6.66%) have shown fair recovery rate .One patient had deep surgical site infection, three patients had transient dysphagia, one had dural injury and one patient had subsidence of TMC. Conclusion: Anterior cervical surgery is safe and effective surgery for single/ double level cervical spondylotic myelopathy (CSM) with less complication rates.