Analysis of Neurogenic Bowel and Bladder Dysfunction Following Decompression Surgery for Cervical Spondylotic Myelopathy: A Prospective Cohort Study

Ryo Kanematsu; Junya Hanakita; Tomoo Inoue; Manabu Minami; Izumi Suda; Sho Nakamura; Manabu Ueno; Toshiyuki Takahashi

doi:10.1177/21925682231202381

Analysis of Neurogenic Bowel and Bladder Dysfunction Following Decompression Surgery for Cervical Spondylotic Myelopathy: A Prospective Cohort Study

Global Spine J. 2023 Sep 14:21925682231202381. doi: 10.1177/21925682231202381. Online ahead of print.

Authors

Ryo Kanematsu¹, Junya Hanakita¹, Tomoo Inoue^{1

2}, Manabu Minami¹, Izumi Suda¹, Sho Nakamura¹, Manabu Ueno³, Toshiyuki Takahashi¹

Affiliations

¹ Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan.
² Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan.
³ Department of Urology, Fujieda Heisei Memorial Hospital, Fujieda, Japan.

PMID: 37707793
DOI: 10.1177/21925682231202381

Abstract

Study design: A prospective observational study.

Objectives: To investigate preoperative prevalence of neurogenic bowel dysfunction and neurogenic bladder in patients with degenerative cervical myelopathy (DCM) and examine the degree and timing of symptom improvement after cervical decompression surgery. Factors contributing to symptom improvement were also analyzed.

Methods: Among 75 patients with DCM who underwent cervical decompression, Constipation Scoring System (CSS) score, International Prostate Symptoms Score (IPSS), and Japanese Orthopaedic Association (JOA) score were assessed before surgery and 1, 3, 6, and 12 months after. Prevalence rates were calculated. Data regarding patient age, sex, disease status, disease duration, lesion level, and score changes was prospectively recorded and analyzed.

Results: The prevalence rates of defecation and urinary dysfunction before surgery were 41.3% and 34.7%, respectively. Among the patients with defecation dysfunction, the number of patients who improved 1, 3, 6, and 12 months after surgery was 10, 9, 9, and 6, respectively. Among the patients with urinary dysfunction, the corresponding number of patients was 12, 10, 11, and 11, respectively. None of the factors we examined were significantly associated with improvement in either CSS or IPSS score; however, improvement of lower extremity JOA score tended to be associated with improvement in both.

Conclusions: The prevalence of symptoms of defecation and urinary dysfunction in patients with DCM was 41.3% and 34.7%, respectively. Decompression surgery improved symptoms in 20% to 46% of patients.

Keywords: constipation scoring system; degenerative cervical myelopathy; international prostate symptoms score; neurogenic bladder; neurogenic bowel dysfunction.