cervical spondylotic myelopathy: the pattern of neurologic def icits and improvement following anterior

we evaluated the specific pattern of pre- and postoperative neurological signs and symptoms of cervical spondylotic myelopathy (csm) to determine [mdings which had a predictive value for surgical outcome. consecutive patients with csm caused by osteophytic ridge or intervertebral disc herniation who underwent anterior cervical decompression and fusion in loghman hakim hospital from 1999-2003 were prospectively enrolled. patients were evaluated postoperatively by office visit. outcome was assessed by objective neurological examination and scoring with multiple functional rating scales. forty - three patients (30 male, 13 female) with a mean age of 48.8 years fulfilled our inclusion criteria. the most common preoperative symptoms were sensory deficit in distal upper limbs (88.4%), gait disturbance (69.8%) and sensory deficit of distal lower limbs (58.1 %). the most common signs were hyperreflexia (95.3%), hoffman's sign (93%) and babinski's sign (83.7%). vertebral osteophyte and soft disc herniation were found in 86% and 14% of the patients, respectively. overall functional improvement, evaluated by using a modification of the japanese orthopedic association scale was noted in 79.7% of the patients who had an abnormal scale preoperatively. strength improved considerably and significantly after operation. however, less than half of the patients experienced functional improvement in the lower limbs, a discrepancy that was probably caused by persistent spasticity. atrophy of the hand muscles, preoperative spastic gait and cord atrophy as shown in mri were poor prognostic factors.