Our experience on cervical spondylotic myelopathy at Dakar (Senegal)

Introduction Pathophysiological mechanism of cervical spondylotic myelopathy is related to a conflict between the spinal cord and a narrow cervical canal which could arise from developmental or degenerative process. Surgical options and prognosis factors are still controversial. Patients and Method: Our study is prospective and not randomized. Over a period of three years, from October, 2007 to October, 2010, 38 patients presenting cervical spondylotic myelopathy went to surgery. We made analysis of some parameters like age, the duration of symptoms before surgery, presence or not of T2 hypersignal and the type of surgical approach which has been used. A follow up was done using and JOA scoring. Statistical calculation is done using Epidata and SPSS software. Results Median age was 54.97 with a range going from 32 to 80 years old. Sex ratio was 5/1 male over female. 73.68 percent of the patients were seen at the hospital because of walking problem and 55.2 percent for grasping difficulties .The average duration of symptoms before surgery was 14.26 months. The mean pre operative JOA score was 9.5/17. On pre therapeutic MRI evaluation 90 percent of the patients shown intra medullary hypersignal at T2 sagittal sequence; the level of the stenosis which is more involved is located on C5C6 (94.73%). 29 patients (76.31%) were operated via posterior approach with a laminectomy and only on 9 patients underwent anterior approach. Mean follow up was 9 months; the functional recovery scoring was 50.46% in 12 months and precisely the mean JOA score improved up to 13.25. Analysis of prognosis factors revealed that length of time of the symptom before surgery and the degree of handicap are predictive factor for recovery. Though, age of the patient, the importance of cervical canal compromise and the presence of T2 hypersignal on MRI do not seem to impact on post operative outcome. Conclusion The incidence of spondylotic cervical myelopathy in Senegal is certainly underestimated. Laminectomy without posterior instrumentation remains our main therapeutic option.