European Spine Journal

, Volume 16, Issue 12, pp 2096–2103

Analysis of five specific scores for cervical spondylogenic myelopathy

Original Article

Abstract

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathy-scale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre- and postoperatively. The correlation between the score-results, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23–37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P < 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.

Keywords

Cervical myelopathy Scores Outcome Recovery rate Preoperative validation Postoperative validation 

References

  1. 1.
    Batzdorf U, Batzdorf A (1988) Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 22:827–836PubMedCrossRefGoogle Scholar
  2. 2.
    Bohlmann HH. (1995) Cervical spondylosis and myelopathy. Instr Course Lect 44:81–98Google Scholar
  3. 3.
    Chagas H, Domingues F, Aversa A et al (2005) Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol 64(Suppl 1):30–35 (discussion: 35–36)CrossRefGoogle Scholar
  4. 4.
    Chiles BWR, Leonard MA, Choudhri HF et al (1999) Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery 44(4):762–769 (discussion: 769–770)PubMedCrossRefGoogle Scholar
  5. 5.
    Cooper PR, Epstein F (1985) Radical resection of intramedullary spinal cord tumors in adults. Recent experience in 29 patients. J Neurosurg 63:492–499PubMedGoogle Scholar
  6. 6.
    Davis R (1996) A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Surg Neurol 46:523–533PubMedCrossRefGoogle Scholar
  7. 7.
    Emery SE. (2001) Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 9(6):376–388PubMedGoogle Scholar
  8. 8.
    Fessler RG, Steck JC, Giovanini MA (1998) Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery 34(2):257–265CrossRefGoogle Scholar
  9. 9.
    Harada A, Mimatsu K. (1992) Postoperative changes in the spinal cord in cervical spondylotic myelopathy demonstrated by magnetic resonance imaging. Spine 17:1275–1280PubMedCrossRefGoogle Scholar
  10. 10.
    Herdmann J, Linzbach M, Krzan M et al (1994) The European myelopathy score. In: Baucher BL, Brock M, Klinger M (eds) Advances in neurosurgery. Springer, Berlin, pp 266–268Google Scholar
  11. 11.
    Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with cervical posterior longitudinal ligament. Spine 6(4):354–364PubMedCrossRefGoogle Scholar
  12. 12.
    Houten JK, Cooper PR. (2003) Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery 52(5):1081–1087 (discussion: 1087–1088)PubMedCrossRefGoogle Scholar
  13. 13.
    Hukuda S, Xiang LF, Imai S et al (1996) Large vertebral body, in addition to narrow spinal canal, are risk factors for cervical myelopathy. J Spinal Disord 9:177–186PubMedCrossRefGoogle Scholar
  14. 14.
    Jörg J. (1992) Rückenmarkerkrankungen. VCH Weinheim, Basel, CambridgeGoogle Scholar
  15. 15.
    Keller A, von Ammon K, Klaiber R et al (1993) Die spondylogene zervikale myelopathie: konservative und operative Therapie. Schweiz Med Wochenschau 123:1682–1691Google Scholar
  16. 16.
    King JTJ, Moossy JJ, Tsevat J et al (2005) Multimodal assessment after surgery for cervical spondylotic myelopathy. J Neurosurg Spine 2(5):526–534PubMedCrossRefGoogle Scholar
  17. 17.
    King JT, McGinnis KA, Roberts MS (2003) Quality of life assessment with the medical outcomes study short-form-36 among patients with cervical spondylotic myelopathy. Neurosurgery 52(1):113–121PubMedCrossRefGoogle Scholar
  18. 18.
    Law MDJ, Bernhardt M, White AA (1995) 3rd. Evaluation and management of cervical spondylotic myelopathy. Instr Course Lect 44:99–110Google Scholar
  19. 19.
    Lyu RK, Tang LM, Chen CJ et al (2004) The use of evoked potentials for clinical correlation and surgical outcome in cervical spondylotic myelopathy with intramedullary high signal intensity on MRI. J Neurol Neurosurg Psychiatry 75(2):256–261PubMedGoogle Scholar
  20. 20.
    Naderi S, Özgen S, Pamir MN et al (1998) Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 43(1):43–49 (discussion: 49–50)PubMedCrossRefGoogle Scholar
  21. 21.
    Nurick S (1972) The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain 95(1):87–100PubMedCrossRefGoogle Scholar
  22. 22.
    Nurick S (1972) The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain 95(1):101–108PubMedCrossRefGoogle Scholar
  23. 23.
    Orr RD, Zdeblick TA. (1999) Cervical spondylotic myelopathy. Approaches to surgical treatment. Clin Orthop 359:58–66PubMedCrossRefGoogle Scholar
  24. 24.
    Pallis C, Jones AM, Spillane JD (1954) Cervical spondylosis. Brain 77:274–289PubMedCrossRefGoogle Scholar
  25. 25.
    Payne EE (1959) The cervical spine and spondylosis. Neurochirurgia 1:178–196PubMedGoogle Scholar
  26. 26.
    Prolo D, Oklund SA, Butcher M (1986) Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11(6):601–606PubMedCrossRefGoogle Scholar
  27. 27.
    Rajshekhar V, Kumar GS (2005) Functional outcome after central corpectomy in poor-grade patients with cervical spondylotic myelopathy or ossified posterior longitudinal ligament. Neurosurgery 56(6):1279–1284 (discussion: 1284–1285)PubMedCrossRefGoogle Scholar
  28. 28.
    Rattcliff J, Voorhies RM. (2001) Outcome study of surgical treatment for axial neck pain. South Med J 94(6):595–602Google Scholar
  29. 29.
    Restuccia D, Di Lazzaro V, Lo Monaco M et al (1992) Somatosensory evoked potensials in the diagnosis of cervical spondylotic myelopathy: preliminary data. Electromyogr Clin Neurophysiol 32:389–395PubMedGoogle Scholar
  30. 30.
    Schön H (1999) Stellenwert der somatosensibel evozierten Potentiale in der prä- und postoperativen Beurteilung der zervikalen spondylophytär bedingten Myelopathie. Innaugural dissertation Leipzig 92Google Scholar
  31. 31.
    Suda K, Abumi K, Ito M et al (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine 28(12):1258–1262PubMedCrossRefGoogle Scholar
  32. 32.
    Yamazaki T, Yanaka K, Uemura K et al (2003) Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52(1):122–126PubMedCrossRefGoogle Scholar
  33. 33.
    Yonenbou K, Fuji T, Ono K et al (1985) Choice of surgical treatment for multisegmental cervical spondylotic myelopathy. Spine 10:710–716CrossRefGoogle Scholar
  34. 34.
    Yue WM, Tan SB, Tan MH et al (2001) The Torg-Pavlov-ratio in cervical spondylotic myelopathy: a comparative study between patients with cervical spondylotic myelopathy and a nonspondylotic, nonmyelopathic population. Spine 26(16):1760–1764PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  1. 1.Neurosurgical clinic of the University LeipzigLeipzigGermany

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