Surgical treatment of multilevel cervical spondylosis in patients with or without a history of syringomyelia

Cervical spondylotic myelopathy (CSM) is the commonest spinal cord disease in adults. This paper compares patients who developed CSM after successful treatment of syringomyelia to those with CSM exclusively related to degenerative spinal disease. In this prospective study, 70 consecutive patients with CSM and spondylotic changes in at least three levels underwent 73 operations between 2005 and 2015 (mean follow-up: 39 +/- 36 months). Patients with treated syringomyelia (group A, n = 30) and those without (group B, n = 40) were distinguished. Japanese Orthopaedic Association (JOA) and European Myelopathy scores (EMS), Karnofksy scores, and scores for individual symptoms were compared. Long-term outcomes were analyzed with progression-free survival rates. Patients of group A were significantly younger with a significantly longer history and lower functional scores compared to group B. 59 laminectomies C3-C6 plus lateral mass fixations, six ventral decompressions with fusion, and eight combined approaches were performed. In both groups, mean JOA (A 9.5 +/- 4.3-10.0 +/- 4.7; B 11.3 +/- 3.7-12.3 +/- 4.3), EMS (A 11.4 +/- 2.9-12.0 +/- 3.1; B 12.2 +/- 3.1-13.5 +/- 3.3), and Karnofsky scores (A 59 +/- 18-62 +/- 18; B 68 +/- 13-72 +/- 15) increased in the first postoperative year with lower scores in group A throughout. Rates for progression-free survival for 5 years were similar in both groups (A 64.2%, B 65.6%). Patients with CSM benefit from decompressive surgery. Surgery should be advocated early for all symptomatic patients with a history of syringomyelia. These patients are at risk for diagnostic delay and worse postoperative results.