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Not all Results after Neck Surgery are Equal

Does surgery help patients with cervical spondylotic myelopathy (CSM)? Not according to this and other studies. CSM is a compression of the spinal cord in the neck. It can cause neck pain, hand numbness and clumsiness, and problems walking. Patients also report changes in bladder function. Some men are impotent.

Two groups of patients with CSM were compared using different methods of treatment. The first group had surgery to take the pressure off the spinal cord. The second group didn't have surgery.

Results were measured using three different scales. Each scale measured symptoms, ability to walk, sensory loss, or other measures of function. There wasn't agreement in the results from these tools. One scale showed patients improved. A second scale showed no change. Scores declined with the third scale. Overall the results of surgery were "unimpressive" in the words of the surgeons.

The authors offer some possible reasons for these results. Perhaps the scales don't measure changes that DO occur with surgery. Maybe a different way to measure change is needed. It's possible that any improvement is a placebo effect because the patient had surgery.

One final explanation for the poor surgical results may be the short follow-up period (only six months). Many surgeons think the main benefit of spinal surgery For CSM is to slow or stop its progression. Long-term studies are needed with a large number of patients to really answer the question of surgery or no surgery for CSM.

References: Joseph T. King Jr, MD, et al. Multimodal Assessment after Surgery for Cervical Spondylotic Myelopathy. In Journal of Neurosurgery: Spine. May 2005. Vol. 2. Pp. 526-534.

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