Noriyuki Ando

Conservative treatment for cervical spondylotic myelopathy. prediction of treatment effects by multivariate analysis.

BACKGROUND CONTEXT Many studies have suggested only slight effects of conservative treatment on cervical spondylotic myelopathy (CSM), whereas a few reports describe conservative treatment as being effective. This suggested the influence of various factors on treatment outcomes. PURPOSE We investigated symptomatic changes after conservative treatment in patients based on a clear understanding of the effects and limitations of conservative treatment. STUDY DESIGN We have encountered cases that showed symptomatic improvement with conservative treatment and became interested in the effectiveness of conservative treatment for CSM and whether other factors affect the results of conservative treatment. PATIENT SAMPLE We have analyzed the results of conservative treatment for CSM in 69 cases, derived from a population of 101 CSM cases. OUTCOME MEASURES Symptoms at the time of the first examination were compared with those at the final examination, and the patients were classified into three groups showing improvement, no change or exacerbation. METHODS Improvement or exacerbation of the symptoms was used as dependent variables and the collected factors as independent variables, and logistic regression was performed on these variables. RESULTS Multivariate analysis showed significant correlation between clinical outcome and the disease duration and the presence of rigorous conservative treatment. CONCLUSIONS Conservative treatment for CSM is considered to be effective if it is performed intensively in selected patients. In treating CSM, the therapeutic approach must be selected first in consideration of the patients disease duration. Conservative treatment must be carried out intensively after sufficient explanation to the patients. Timely surgical intervention is considered to be important if the symptoms show no change or exacerbation with conservative treatment.

Original submissionConservative treatment for cervical spondylotic myelopathy: prediction of treatment effects by multivariate analysis☆☆☆

BACKGROUND CONTEXT Many studies have suggested only slight effects of conservative treatment on cervical spondylotic myelopathy (CSM), whereas a few reports describe conservative treatment as being effective. This suggested the influence of various factors on treatment outcomes. PURPOSE We investigated symptomatic changes after conservative treatment in patients based on a clear understanding of the effects and limitations of conservative treatment. STUDY DESIGN We have encountered cases that showed symptomatic improvement with conservative treatment and became interested in the effectiveness of conservative treatment for CSM and whether other factors affect the results of conservative treatment. PATIENT SAMPLE We have analyzed the results of conservative treatment for CSM in 69 cases, derived from a population of 101 CSM cases. OUTCOME MEASURES Symptoms at the time of the first examination were compared with those at the final examination, and the patients were classified into three groups showing improvement, no change or exacerbation. METHODS Improvement or exacerbation of the symptoms was used as dependent variables and the collected factors as independent variables, and logistic regression was performed on these variables. RESULTS Multivariate analysis showed significant correlation between clinical outcome and the disease duration and the presence of rigorous conservative treatment. CONCLUSIONS Conservative treatment for CSM is considered to be effective if it is performed intensively in selected patients. In treating CSM, the therapeutic approach must be selected first in consideration of the patients disease duration. Conservative treatment must be carried out intensively after sufficient explanation to the patients. Timely surgical intervention is considered to be important if the symptoms show no change or exacerbation with conservative treatment.

Clinical Studies of Expansive Laminoplasty for Ossification of the Posterior Longitudinal Ligament of the Cervical Spine.

We investigated the clinical results of 39 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent expansive laminoplasty by sagittal splitting of the spinous process (Kurokawa’s method), from January 1995 to October 2000. The mean age was 62 (42 to 75) years. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 38 (12 to 77) months. The mean JOA score was 7.82 points before surgery and 12.73 points after surgery. The overall mean recovery rate by JOA score was 52.5%. The patients were divided into two groups; Group 1 consisting of 8 patients with spinal canal stenosis due to OPLL or ossification of the ligamentum flavum etc. at the thoracic and/or lumbar level, and Group 2 consisting of 31 patients without stenosis. The mean JOA score of Group 1 was 6.75 points before surgery and 10.94 points after surgery, while the score of Group 2 was 8.10 points before surgery and 13.20 points after surgery, with no significant difference in the score before surgery between the two groups. However, the JOA score after surgery was significantly lower in patients with spinal canal stenosis at the thoracic and/or lumbar level of Group 1, than the patients without stenosis in Group 2.

Surgical Treatment for Cervical Myelopathy in Young Adult Patients under 40 Years Old.

We investigated the clinical results in 28 young adult patients with cervical myelopathy under 40, from January 1990 to December 2001. Four patients were female and 24 were male. The diagnosis was disc herniation in 19 patients, ossification of the posterior longitudinal ligament (OPLL) in 3, athetoid cerebral palsy in 3, Klippel-Feil syndrome in 1, and developmental canal stenosis without other cervical disease in 2. Their mean age was 34 (22 to 40) years. Nineteen patients were treated by expansive laminoplasty, and the other 9 by anterior interbody fusion. The operative results were evaluated according to the Japanese Orthopaedic Association (JOA) score, after a mean follow-up period of 44 (2-139) months. The mean JOA score was 11.0 points before surgery and 15.1 points after surgery. The overall mean recovery rate by JOA score was 63.2%. The preoperative and postoperative JOA scores were significant lower in patients with a preoperative long duration of symptoms compared with patients with a short duration of symptoms before surgery. These results suggest that early surgical treatment provides satisfactory results in young adult patients with cervical myelopathy.