Validation of a novel scoring system (Cervical Surgical Score) for the management of degenerative cervical myelopathy.

BACKGROUND

Degenerative Cervical Myelopathy (DCM) is the leading cause of spinal cord dysfunction globally. Surgical intervention is often recommended for moderate to severe cases, but the optimal surgical approach remains debated.

OBJECTIVE

This study aims to validate the novel Cervical Surgical Score (CSS) for managing DCM, aiding surgical decision-making.

METHODS

A prospective study was conducted in Carlo Besta institute (Milan) from a consecutive series, enrolling 113 patients undergoing surgery for DCM from January 2022 to February 2023. This cohort was compared with 106 patients from a retrospective cohort treated between 2019 and 2021.

RESULTS

A total 219 patients (113 prospective, 106 retrospective) were included. The prospective group had an average age of 59.6 years (61 % males), and the retrospective group, 60.7 years (69 % males). The mean CSS score (calculated based on age, level of cervical pathologies, level of myelopathy, extension, site and type of compression, cervical alignment and mJOA) was 12.3 for prospective and 13.18 for retrospective groups. Most prospective cases used an anterior approach compared to retrospective group (88,5 % vs 48.1 %). At two years, neurological recovery (last follow-up mJOA-preoperative mJOA)/(18-preoperative mJOA × 100) was higher in prospective group (68 % vs. 54 %). CSS concordance linked to better recovery rates at one and two years (45 % and 66 % vs. 29 % and 47 %; p < 0,001). High-expertise surgeons (defined based on case-load evaluation scale) achieved higher CSS concordance (64 %) than medium (31 %) and low-expertise surgeons (0 %).

CONCLUSION

The CSS is a reliable tool for optimizing surgical strategies for DCM, enhancing decision-making, and improving patient outcomes.