Cervical spondylotic myelopathy. Clinical aspects and surgical indications: about a series of 66 patients

The aim of this study was to review the clinical features as well asthe surgical indications and results in a series of 66 patients withcervical spondylotic myelopathy treated at the Niamey nationalhospital, Niger, over a 5 years period. The clinical condition beforeand after surgery was assessed using a functional score. All patientshad a simple cervical spine x-ray. Patients selected for a posteriorprocedure also had a dynamic radiographic study. Myelographywas performed for most patients and a few had a CT scan. TheSmith-Robinson procedure was performed for 1-level or 2 levelsspondylotic lesions, and for 3-levels lesions only if there was a lossof cervical lordosis. For compressions extending over more than 3levels, a C3-C7 laminectomy was performed. A Smith-Robinsonprocedure preceded laminectomy when instability was demonstrated.Patients’ age ranged from 32 to 67 years (average: 55.5 years) with61% males. 87.9% of the patients presented with a preoperativefunctional score ranging from 2 to 4. Myelography was performedon 92.4% of patients. A simple cervical x-ray was sufficient to confirmthe surgical indication for 5 patients. The anterior procedurewas performed in 21 cases and posterior procedure in 45 cases. Inthree cases, an anterior procedure was done prior to laminectomybecause of instability. The authors recorded one case of bone graftexpulsion and one case of meningitis. The follow-up time was 3months (67% of patients). Results were judged unsatisfactory for12.1% of patients, medium for 33%, good for 42.4% and excellentfor 12.1%.The spine cord recovery might be affected by the duration of symptomsand by the preoperative functional grade. The authors recommenda posterior procedure for advanced myelopathies.