Effect of Surgical and Non Surgical Modalities in the Management of Cervical Spondylosis: A Prospective Interventional Study from a Tertiary Care Hospital

Abstract

Introduction: Cervical spondylosis is an age-related degenerative condition of cervical spine that leads to compression of exiting nerve roots and in more severe cases compression of spinal cord, giving rise to symptoms of radiculopathy and myelopathy, respectively. Till date there have been various studies on the management of cervical spondylosis, some supporting the conservative line of management whereas others favouring the surgical approach. But still there is no clear consensus about which line of management is better than the other. Aim: To assess the role of surgical and non surgical modalities in the management of cervical spondylosis using the American Spinal Injury Association (ASIA) and Visual Analog Scale (VAS) scores. Materials and Methods: The present prospective interventional study was conducted on a total sample of 100 patients presenting in Outpatient Department (OPD) of Department of General Surgery, Hamidia Hospital, Bhopal, Madhya Pradesh, India, who were diagnosed to have cervical spondylosis, between November 2018 to July 2020. Patients were divided into two groups based on the mode of intervention i.e. surgical and non surgical groups. Preintervention and Postintervention scores were recorded according to ASIA scale (which included sensory and motor score) and VAS for pain score. The significance of change in these scores was determined by using Paired t-test. The data was analysed using XLSTAT version 2021.5.1. Results: Total 100 patients included initially, 14 patients were lost to follow-up. The remaining 86 patients were evaluated and included in the final analysis. Out of these 86 patients, 80 were managed conservatively and six underwent surgical management. Under the conservative group, the mean preinterventional motor score was found to be 43.3±5.99 which improved to 45.7±4.78 postinterventional (p<0.001). The mean preinterventional sensory score was 105.9±6.33 which improved to 108.6±4.50 postinterventional (p<0.001) and the pain score changed from 5.17±1.14 preinterventional to 4±1.40 postinterventional (p<0.001). Similarly, in the surgical group, the mean preinterventional motor score was 31.6±4.08 which improved to 37.1±7.33 postinterventional (p=0.038). The mean sensory score changed from 90.8±16.13 preinterventional to 99.1±8.16 postinterventional (p=0.107) and the pain score improved from 7.5±1.05 preinterventional to 6.3±1.37 postinterventional (p=0.034). The p-value was found to be highly significant for the conservative group and significant for the surgical group except the sensory scores. Conclusions: Both the interventions, non surgical and surgical interventions were found to be effective. The conservative or the non surgical approach led to improvement in all three components (motor, sensory and pain), whereas the surgical management was found beneficial only in terms of motor and pain compartment, the sensory compartment did not show any significant benefit in present study.

Keywords

• cervical pain
• discectomy
• myelopathy
• radiculopathy