Tratamento cirúrgico por via anterior na mielopatia cervical espondilótica com seguimento mínimo de dez anos

Objective: cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction in the adult population. The treatment implies early surgical decompression. The objective was to present a retrospective study of anterior decompression and arthrodesis for CSM with a minimal ten years follow-up. Methods: patients operated between January 1990 and December 1994 were evaluated for sex, age, number of levels operated, functional evaluation with Nurick scale preoperatively, one year after surgery and at the final revision that took place in 2004, evidence of consolidation and complications. Results: 91 patients were evaluated, 69 male, 22 female, with a mean age of 56.6years (42-86) and mean follow-up of 11.9 years. Five deaths occurred: three patients died in the immediate postoperative period, one in the first year and one during the follow-up. A mean of 2.7±1.0 levels for patient was performed (1-4). The mean value of preoperative Nurick was 3.8±0.9. There was a significant improvement in neurological condition after one year (2.2±1.1; p<0.001), and between preoperative period and final evaluation (2.3±1.2; p<0.001). The degradation between the first year and the final evaluation was statistically significant (p=0.004). There was a strong correlation between age and the number of operated levels (r=0.391; p=0.01), age and initial neurologic status (r=0.238; p=0.05), initial neurological status and number of operated levels (r=0.251; p=0.05) and sex and number of operated levels, with women being operated for more levels (r=0.208; p=0.05). There was also a stronger neurological deterioration between the first year and the final follow-up in young patients when compared to older ones (r=0.25; p=0.05). There is a strong relation between the first year improvement and the final improvement (r=0.838, P=0.01). There was a 100% rate of consolidation. Conclusion: in CSM, a significant neurological improvement can be expected with surgery, and despite a clinical deterioration between the first year and the final evaluation, the benefits of decompression are evident at least ten years after the intervention.