Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study.

ABSTRACT

STUDY DESIGN: A 3-year prospective randomized study was conducted. OBJECTIVE: To compare conservative and operative treatments of mild and moderate, nonprogressive, and slowly progressive forms of spondylotic cervical myelopathy. SUMMARY OF BACKGROUND: DATA It is not known whether the results of decompressive surgery for the mild and moderate forms of spondylotic cervical myelopathy are any better than those of the conservative approach. METHODS: For this study, 68 patients were randomized into two groups. Group A, treated conservatively, consisted of 35 subjects, whereas Group B, treated surgically, was composed of 33 patients. The clinical outcome was evaluated by modified JOA score, timed 10-m walk, the score for daily activities recorded by video and evaluated by two observers blinded to the type of therapy, and subjective assessment by the patients themselves at months 6, 12, 24, and 36 of the follow-up period. RESULTS: There was, on the average, no significant deterioration in mJOA score in the two groups over the 3-year follow-up period, but there was a slightly expressed decrease in the self-evaluation score in Group B, and a slight deterioration of the score for daily activities in Group A. Comparison of the two groups showed a significant difference in the timed 10-m walk test favoring group A, but no difference in mJOA score or self-evaluation by the patients themselves, with the exception of a better score at month 6 in favor of Group B. CONCLUSIONS: The 3-year follow-up study did not show, on the average, that the surgery is superior to conservative treatment for mild and moderate forms of spondylotic cervical myelopathy.