Outcome of conservative treatment of spondylotic cervical myelopathy and the predictive value of the magnetic resonance imaging findings

Abd Elateef, Gaber Saad; Hassan, Mahmoud Mohamad; Abo Almakarem, Mohamad Abd Al Hady; Mohamad Hassan, Hossam Aldeen

doi:10.4103/1110-1148.182313

Outcome of conservative treatment of spondylotic cervical myelopathy and the predictive value of the magnetic resonance imaging findings

Authors

Abstract

Background
Cervical spondylotic myelopathy (CSM) is a common neurological problem both in the young and old. Although surgical decompression has been the treatment of choice for cervical compressive myelopathy, conservative treatment is an alternative therapeutic option for mild cervical myelopathy.
Patients and methods
Forty-six patients with mild-to-moderate CSM were conservatively treated for 6 months and evaluated using the Japanese Orthopedic Association (JOA) scores to see the outcome. On the basis of outcome they were divided into two groups: group A included those with good outcome and group B included those with poor outcome. Both groups were compared as regards the JOA scores and MRI findings.
Results
The JOA scores were as follows: 12.5 ± 1.8 in group A and 11.7 ± 1.43 in group B before treatment, and 16.3 ± 1.02 for group A and 12.53 ± 1.28 for group B at the final follow-up. Good outcome was obtained in 63% of the patients after conservative treatment. On MRI, paramedian type is associated with good outcome and focal increased signal intensity is associated with good outcome. However, median-type and multisegmental increased signal intensity are associated with poor outcome.
Conclusion
We conclude that there is a significant association between the MRI findings and the outcome following conservative treatment of CSM, and the conservative line of treatment is effective.

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