Clinical efficacy of cervical decompression surgery in the treatment of cervical spondylotic myelopathy complicated with amyotrophic lateral sclerosis

English Keywords:Cervical spondylotic myelopathy  Amyotrophic lateral sclerosis  Comorbidity  Cervical decompressive surgery  Treatment outcome

English Abstract:

  【Abstract】 Objectives: To investigate the functional outcomes and survival of cervical decompression surgery in patients with cervical spondylotic myelopathy(CSM) complicated with amyotrophic lateral sclerosis(ALS). Methods: A retrospective cohort study was conducted on 22 patients(19 males, 3 females; aged 44-76 years, mean 58.7±9.1 years) diagnosed with both CSM and ALS who underwent cervical decompression surgery at our institution. Neurological functional status and quality of life were assessed preoperatively and at final follow-up using the visual analog scale(VAS), neck disability index(NDI), modified Japanese Orthopaedic Association(mJOA) scale, 36-item short-form health survey(SF-36), and ALS functional rating scale-revised(ALSFRS-R). The monthly decline rate of ALSFRS-R(ΔFS) was calculated. Overall survival was evaluated using Kaplan-Meier survival analysis. Results: All patients successfully underwent cervical surgery without major perioperative complications. The follow-up duration ranged from 2 to 18 months(5.2±3.5 months). During follow-up, most patients exhibited progressive functional deterioration. VAS score increased from 2.0(0.0, 3.0) to 2.0（0.0, 3.0） and NDI from 7.86±6.55 to 18.50±11.16(both P<0.01). The mJOA score declined from 12.41±1.89 to 10.43±2.34(P<0.01), with only two patients(9.1%) showing slight improvement. The ALSFRS-R total score decreased from 42.47±4.46 to 37.63±10.10, with significant declines in bulbar, fine motor, and gross motor subscores(all P<0.01), while respiratory function showed no significant change(P=0.08). The mean ΔFS was 0.70±0.45 points per month. SF-36 scores declined across several domains, particularly bodily pain, vitality, and mental health. Kaplan-Meier analysis demonstrated five deaths(22.7%) during follow-up, with an estimated survival rate of approximately 82% at 12 months and 48% at 18 months, consistent with previously reported survival patterns and natural progression of ALS. Conclusions: In patients with coexisting CSM and ALS, cervical decompression surgery cannot alter the natural course of ALS and is associated with continued decline in neurological function and quality of life.