Aims and Objective: Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyse the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment. Materials and Methods: To prospectively assess and compare the pre- and post-operative clinical and functional status of patients with CSM using the modified Japanese Orthopaedic Association (mJOA) scores and the modified Myelopathy Disability Index (mMDI) scores at baseline, 3, 6- and 12-monthspost-surgery. The following factors were evaluated: age at presentation; gender; cigarette smoking; duration of symptoms; presence of T2WI cord signal cord abnormality on MRI. We also assessed recovery / progression of individual aspects of the mJOA: upper limb; lower limb; sensation and sphincters in both groups. Severity of CSM was assessed as mild if baseline mJOA scorewas≥12andmoderate-severeifbaselinemJOAscorewas<12. Results: Surgery was associated with significant improvement in clinical recovery as assessed by mJOA scores at 3, 6 and 12 months post-operatively. Upper limb function improved after surgery as assessed by the upper limb component of the mJOA score at 3, 6 and 12 months. Lower limb function also improved significantly as assessed by the lower limb recovery scores at 3, 6 and 12 months. Sensation and sphincter function did not improve after surgery. There was significant functional recovery as assessed by mMDI scores at 3, 6 and 12 months after surgery. Conclusions: Patients with CSM benefit from surgical decompression regardless of baseline severity, with significant clinical and functional improvement noted at least 12 months post-operatively. Upper and lower limb function improves significantly, but sensation and sphincter function do not recover. The occurrence of intraoperative complications results in a worse outcome and this negative effect is still seen 12 months post-operatively. Patients who are managed non-operatively do not show significant improvement and 42% have some clinical deterioration at 12 months. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.

Keywords: Cervical spondylotic myelopathy; Modified Japanese Orthopaedic Association; Modified Myelopathy Disability Index.