Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system
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ORIGINAL ARTICLE
Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system Fabio Pilato 1
&
Rosalinda Calandrelli 2 & Marisa Distefano 3 & Francesco Ciro Tamburrelli 4,5
Received: 18 January 2020 / Accepted: 28 August 2020 # The Author(s) 2020
Abstract Objective Cervical spondylotic myelopathy (CSM) is caused by cervical spine degeneration and surgery may be beneficial, but selection for surgery might be challenging. We performed a multimodal analysis to assess predicting factors that may be useful to help surgeons in this choice. Patients and methods We retrospectively evaluated clinical, motor evoked potentials (MEP), and MRI data of patients who undergone surgery for CSM. Seventy-six consecutive patients (46 males) were enrolled. The median age was 65.5 [IQR: 57–71] years, and the duration of symptoms was 11 [8–13] months. A multivariate analysis in order to assess predictors of outcome and ROC curve analysis were performed. Results Thirty patients (M:18, 39.5%) gained 6 or more points on mJOA and they were collected in good recovery group, whereas 46 patients (60.5%, M:28) showed a fair recovery. We developed a comprehensive score system (CSS) taking into account clinical, neurophysiological, and neuroradiological data. ROC curve analysis was performed to determine the discriminative power of four models derived from the multivariate logistic regression analysis for predictors of good outcome considering only clinical variables, MRI variables, and MEP variables or considering the comprehensive model, demonstrating a good accuracy of CSS model to predict outcome. Conclusion This study demonstrates that CSS model taking into consideration functional assessment by mJOA score, neurologic evaluation, cervical MRI, and MEP may be a feasible method to predict outcome in patients candidate to surgery, supporting surgeon’s decisions both for those patients candidate to surgery and for patients in whom a “wait and see” approach could be proposed. Keywords Magnetic resonance imaging . Cervical spondylotic myelopathy . Prognosis . Motor-evoked potentials . Myelopathy . Personalized medicine
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04691-0) contains supplementary material, which is available to authorized users. * Fabio Pilato [email protected] Rosalinda Calandrelli [email protected] Marisa Distefano [email protected]
2
UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
3
UOC Neurologia e UTN, Ospedale Belcolle, Strada Sammartinese, 01100 Viterbo, Italy
4
UOC Chirurgia Vertebrale, Dipartimento di scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Fondazione Policlinico Universitario A. Gemelli – IRCCS, Rome, Italy
5
Istituto di Ortopedia, Università Cattolica del Sacro Cuore, Rome, I
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