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2016 ; 7
(2
): 82-6
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Prediction of surgical outcome in compressive cervical myelopathy: A novel
clinicoradiological prognostic score
#MMPMID27217653
Aggarwal RA
; Srivastava SK
; Bhosale SK
; Nemade PS
J Craniovertebr Junction Spine
2016[Apr]; 7
(2
): 82-6
PMID27217653
show ga
CONTEXT: Preoperative severity of myelopathy, age, and duration of symptoms have
been shown to be highly predictive of the outcome in compressive cervical
myelopathy (CCM). The role of radiological parameters is still controversial.
AIMS: Define the prognostic factors in CCM and formulate a prognostic score to
predict the outcome following surgery in CCM. SETTINGS AND DESIGN: Retrospective.
MATERIALS AND METHODS: This study included 78 consecutive patients with CCM
treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale
was used to quantify severity of myelopathy at admission and at 12-month
follow-up. The outcome was defined as good if the patient had mJOA score ?16 and
poor if the score was <16. Age, sex, duration of symptoms, comorbidities,
intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio,
instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal
intensity changes were assessed. STATISTICS: Statistical Package for the Social
Sciences (SPSS) (version 20.0) was used for statistical analysis. The association
was assessed amongst variables using logistic regression analysis. Parameters
having a statistically significant correlation with the outcome were included in
formulating a prognostic score. RESULTS: Severity of myelopathy, IHMW, age,
duration, diabetes, and instability on radiographs were predictive of the outcome
with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and
intensity changes on MRI were not significantly related to the outcome. A 8-point
scoring system was devised incorporating the significant clinicoradiological
parameters, and it was found that nearly all patients (97.82%) with a score below
5 had good outcome and all patients (100%) with a score above 5 had poor outcome.
The outcome is difficult to predict with a score of 5. CONCLUSIONS: Clinical
parameters are better predictors of the outcome as compared to radiological
findings, following surgery in CCM. A simple scoring system based on
clinicoradiological parameters is suggested in this paper to predict the outcome
following surgery in cases of CCM.