Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy

Purpose: To assess the long-term results of anterior cervical discectomy and fusion using the Cloward procedure for the treatment of cervical spondylotic myelopathy, and to identify possible clinical outcome predictors. Methods: A total of 14 cases with a 10-year postoperative follow-up were available (82.4% of the surviving patients). Patients underwent preoperative and postoperative neurologic examination. The symptom severity was graded according to the Nurick scale. MRI measurements were obtained preoperatively. Cervical spine radiographs were obtained preoperatively and at the time of follow-up. Results: The mean improvement of the clinical status of patients on the Nurick scale was 1.43±0.51 (range 1-2) with respect to the baseline values (p<0.001), with a 62.5% recovery rate. A positive association between the improvement of the Nurick scale and the length of follow-up was detected with an age-adjusted univariate analysis (p=0.042). The Nurick grade improvement was also directly related to preoperative lower limb hyperreflexia (p=0.039), spasticity (p=0.017), and bladder dysfunction (p=0.048). At the time of follow-up, an adjacent discopathy was noted above and below the operated level(s) in 8 and 6 patients, respectively. Conclusions: The Cloward technique is a safe and effective procedure for the treatment of cervical spondylotic myelopathy. The patients’ preoperative neurological status and the length of follow-up affect the grade of postoperative ambulatory improvement.