E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Posterior Cervical Surgery for Spondylotic Myelopathy: A Retrospective Cohort Study of 31 Patients with Postoperative Neurological Deterioration
Zühtü OZBEK✉ ,
Gizem BASYAZICI EKINCI ,
Fatih SAGLAM ,
Gultekin BAS
Neurosurgery, Eskişehir Osmangazi Üniversitesi; Neurosurgery, Private Umit Hospital, Eskisehir
Accepted: 10/09/2026
Article in Press
Corresponding Author:
Zühtü OZBEK (zuhtuozbek@gmail.com)
Abstract
Aim
To investigate patterns of neurological recovery and complication profiles in patients with central versus lateral spinal canal compression who experienced postoperative neurological deterioration after PDIF.
Material and Methods
This retrospective single-center study included 31 patients with radiologically confirmed DCSM who developed new or worsened neurological deficits following PDIF between 2012 and 2023. Patients were divided into two groups based on preoperative MRI/CT findings: central compression (Group C) and lateral-extensional compression (Group L). JOA scores were calculated preoperatively, postoperatively, and at 2-year follow-up, and the groups were compared using appropriate statistical tests (repeated measures ANOVA, Friedman test, Nemenyi post hoc).
Results
Of the 31 patients who experienced postoperative neurological deterioration, 14 were in Group C and 17 were in Group L. Patients in Group C (n = 14) experienced a significant decrease in JOA in the early postoperative period (median: 13.0 to 7.5; p < 0.001) and partial improvement within 1 year (median: 11.5; p = 0.017). Patients in Group L (n = 17) experienced a milder initial decrease in JOA (mean: 11.9 to 8.9; p < 0.001), but long-term improvement was limited (1-year mean: 10.5; p = 0.033). C5 palsy was more frequent in Group L than in Group C (29.4% vs. 14.3%). T2-weighted spinal cord signal changes were observed in 5 patients (16.1%).
Conclusion
The morphology of spinal cord compression significantly affects postoperative neurological outcomes in DCSM. Central compression was associated with greater initial neurological deterioration but more substantial subsequent recovery, whereas lateral compression was associated with a higher incidence of root-related complications. These findings suggest that compression morphology may serve as a useful descriptive factor when interpreting postoperative recovery patterns and counseling patients with DSCM.
To investigate patterns of neurological recovery and complication profiles in patients with central versus lateral spinal canal compression who experienced postoperative neurological deterioration after PDIF.
Material and Methods
This retrospective single-center study included 31 patients with radiologically confirmed DCSM who developed new or worsened neurological deficits following PDIF between 2012 and 2023. Patients were divided into two groups based on preoperative MRI/CT findings: central compression (Group C) and lateral-extensional compression (Group L). JOA scores were calculated preoperatively, postoperatively, and at 2-year follow-up, and the groups were compared using appropriate statistical tests (repeated measures ANOVA, Friedman test, Nemenyi post hoc).
Results
Of the 31 patients who experienced postoperative neurological deterioration, 14 were in Group C and 17 were in Group L. Patients in Group C (n = 14) experienced a significant decrease in JOA in the early postoperative period (median: 13.0 to 7.5; p < 0.001) and partial improvement within 1 year (median: 11.5; p = 0.017). Patients in Group L (n = 17) experienced a milder initial decrease in JOA (mean: 11.9 to 8.9; p < 0.001), but long-term improvement was limited (1-year mean: 10.5; p = 0.033). C5 palsy was more frequent in Group L than in Group C (29.4% vs. 14.3%). T2-weighted spinal cord signal changes were observed in 5 patients (16.1%).
Conclusion
The morphology of spinal cord compression significantly affects postoperative neurological outcomes in DCSM. Central compression was associated with greater initial neurological deterioration but more substantial subsequent recovery, whereas lateral compression was associated with a higher incidence of root-related complications. These findings suggest that compression morphology may serve as a useful descriptive factor when interpreting postoperative recovery patterns and counseling patients with DSCM.
Keywords
degenerative cervical myelopathy
posterior decompression and fusion
neurological deterioration
C5 palsy
radiological classification