the disease can cause three different categories of symptoms and signs with possible overlap in the affected patients [ 2 , 3 ] . these patients may complain of the neck ( pain , stiffness , and limited range of motion ) or suffer from radiculopathy or even myelopathy . neurologic symptoms are usually aroused when the space available for the neural elements is reduced by osteophytes , hypertrophied ligamentum flavum , or a herniated disc . in those patients whose main manifestation of the disease is neck complains , conservative treatment is usually recommended , while in some with cervical spondylotic radiculopathy ( csr ) or myelopathy ( csm ) , surgery may be associated with better satisfactory outcomes [ 57 ] . although , some authors still have doubts about the long - term results of surgery in these cases [ 2 , 8 ] . the poor prognostic factors usually quoted in the surgical treatment of the patients include older age , abnormal cervical curvature , multisegmental compression , more duration of symptoms , higher number of comorbidities , decreased signal intensity on t1-weighted images , increased signal intensity on t2-weighted images , and existence of cord atrophy in preoperative magnetic resonance images ( mris ) [ 1 , 5 , 6 , 911 ] . although many papers have been published about the surgical outcome of the patients with csm or csr , according to our knowledge , very few studies have been conducted to compare the two . in this retrospective study , we aim to compare functional outcome of surgery in patients with csr and csm . 910106 ) , we retrospectively reviewed our patients with csm and csr who had been operated from august 2006 to january 2011 . those patients with predominant manifestation of csr were placed in group a , while the others were placed in group b. in rare cases , who complained of both conditions with equal intensity , due to the differences in the clinical significance , we conventionally put them in the second group . our inclusion criteria included refractory complains to aggressive medical treatment more than six weeks , significant neurologic deficit ( especially if progressive ) , and a followup period more than 24 months . we excluded those patients with secondary spondylosis ( due to previous trauma , congenital anomalies , and infectious or inflammatory diseases ) , significant underlying disease ( uncontrolled diabetes mellitus , severe osteoporosis , etc . ) , tandem stenosis ( significant accompanying spinal stenosis in another area of the spine ) , and those who had history of previous surgery . preoperatively , in group b , the presence of increased signal intensity inside the cord on t2-weighted mri was assessed by two self - governing radiologists and was described as positive when they both were in concurrence . we did not grade this increased intensity and only classified it as normal or positive . in this study , surgical techniques and approaches were not considered as the effective variables , and we primarily aimed to efficiently decompress the neural elements and stabilize the spine if necessary . in our opinion , it matters little that this goal would be achieved with anterior or posterior approach , spondylodesis or disc arthroplasty , anterior cervical discectomy or corpectomy , and laminectomy or laminoplasty ; but each technique or approach should be used in its proper patient . after the informed consent form was signed , demographic and imaging data were recorded , and then the patient operated . all the procedures have been carried out by the fist author ( fok ) with a relative similar technique during this period of time . we used neck disability index ( ndi ) as an assessment tool to evaluate functional outcome . translation and validation study of the iranian version of this international questionnaire has been already performed by mousavi in 2007 and proved to be extremely reliable . the ndi questionnaire was completed preoperatively and then every six months after surgery . and patient satisfaction with surgery was also evaluated subjectively . at the last visit , the cases were asked to choose one of the following responses regarding their satisfaction with the surgical treatment , according to criteria adopted from the north american spine society low back outcome instrument : ( 1 ) surgery met my hopes , ( 2 ) i did not improve as much as i had hoped , but i would undergo the same surgery for the same outcome , ( 3 ) surgery helped , but i would not undergo the same treatment for the same outcome , or ( 4 ) i am the same as or worse than i was before the surgery . we used independent samples t - test for comparison and pearson and kendall 's tau - b correlation coefficients for measuring the dependency . statistical package for the social sciences ( spss ) software version 11.5 was used for statistical analysis . initially , 150 patients were eligible for inclusion , but later ten patients due to short duration of followup were excluded . all the surgical approaches in group a were carried out from anterior , while 19.5% of the procedures in group b were performed posteriorly . we operated no patient with combined anterior and posterior approach . in 52 ( 76.5% ) of the patients with radiculopathy ( group a ) , there was only one level of cervical involvement , and in the remaining 16 ( 23.5% ) , two levels of involvement were present . in contrary to group a , in myelopathy group , only 22 ( 30.6% ) of the patients had a monosegmental involvement , and two , three , four , and five levels of involvement were observed in 20 ( 27.8% ) , 16 ( 22.2% ) , 6 ( 8.3% ) , and 8 ( 11.1% ) , respectively . regarding to surgical delay ( the time interval between appearances of complains and surgery ) and its relation to functional recovery ( ndi ) , based on pearson 's correlation coefficient , in group a , the longer delay caused a worse surgical outcome ( ndi ) , while this relationship was not observed in group b. in addition , in group b , there were 30 cases ( 41.7% ) with increased signal intensity inside the cord preoperatively , and based on kendall 's tau - b correlation coefficient , there was no significant relationship between this imaging signal change and our surgical outcomes ( correlation coefficient of 0.12 , p = 0.204 for final ndi ) .   functional status of the patients ( ndi ) before surgery and at last followup visit is shown in table 2 . patient 's satisfaction from the surgery was also assessed at the last followup and depicted in the same table . although in comparing csr with csm patients , satisfactory rates from the surgery seemed to be higher in the first group , this was not significant , statistically . overall , surgery could significantly improve ndi in both groups ( p < 0.001 ) . regarding to improved ndi and patient 's satisfaction score , , we had three implant failures ( all in group a ; screw loosening ) , and three pseudarthroses ( two case in group a and one in group b ) . five cases needed reoperation ( three due to symptomatic pseudarthrosis , one adjacent segment disease , and one symptomatic device loosening ) . one patient in group a had a transient paralysis of the recurrent laryngeal nerve , lasting for two months . three patients had superficial wound infection , all treated by local wound care and antibiotic therapy . we investigated 140 patients with refractory cervical spondylosis who had been treated with surgery . our study showed that the functional results of surgery and patients ' satisfaction rate in csr compared to csm are apparently better but statistically comparable .   usually , it is said that csm compared to csr more commonly occurred in older patients [ 15 , 16 ] . in this study , we were unable to find a significant difference in the age distribution . the sex ratio of the patients reported in different studies is highly variable [ 6 , 11 , 1618 ] . the sex ratios of our patients in the two groups were markedly different from each other ; radiculopathy was more common in women , whereas the opposite is myelopathy . several surgical prognostic factors have been reported in the literature . in a prospective study , older age and greater number of underlying preoperative comorbidities are associated with lower surgical outcome . 65 patients with surgically treated csm found that good prognostic factors in these cases included younger age and lower preoperative baseline modified japanese orthopaedic association score , but the severity of cord compression , signal intensity change on magnetic resonance imaging scans , and treatment delay have little prognostic value . our research results also confirmed that signal change and treatment delay had no adverse effect on functional outcome of these patients . vice versa , chatley et al . , in 2009 , in a research on 64 cases with a 6-months followup period showed that the signal change indicative of a chronic constrictive lesion was a predictor of poor surgical results . naderi also found that age less than 60 , normal preoperative cervical lordosis , and normal signal intensity ( versus increased signal intensity on t2 mri ) within the spinal cord were associated with more favorable neurological postoperative improvements . as we noted , we did not consider the surgical techniques and approaches as the effective variables and assumed that for each patient , a proper decompressive surgery with or without spinal stabilization ( if indicated ) has been carried out . in a relatively large systematic review carried out by mummaneni et al . , they used evidence - based medicine to judge against different surgical decompressive techniques commonly used in csm patients . ultimately , the researchers concluded that these variable techniques had comparable outcome , and the surgical technique can not be an important factor in determining the proper results , although they noted that laminectomy seemed to have a delayed worsening rate . this rule also applies to the patients with csr , and decompression itself is still the main principle of treatment . in our study , only six cases in group b had laminectomy alone ( without associated posterior instrumented fusion ) and this small number could not have a great impact on the overall conclusions .   in the study , we conducted that 88.2% of the csr patients and 77.8% of the csm patients had good or excellent results ( patient satisfaction score 1 or 2 ) , while 5.9% and 16.7% , respectively , showed postoperative deterioration ( score 4 ) . to compare the results evaluated 76 patients with csr who are treated by 1 or 2 level anterior cervical discectomy and fusion . he categorized then into group a ( iliac crest bone graft alone ) and group b ( iliac crest bone graft and plating ) . he reported 55% and 88.9% excellent or good results in groups a and b , respectively . the other study ( related to radulovi et al . ) has been carried out on 57 surgically treated patients with csm that showed good functional improvement irrelevant to the chosen surgical approach . in this study , 75% of the cases showed postoperative improvement , while 21% remained unchanged and 4% deteriorated . in comparison with these two studies , the major limitations of our study are our retrospective method of research and diversity in surgical techniques . obviously , a randomized control trial study will be able to offer stronger advices . in the future , it is suggested in order to decrease the confounding effect of the surgical type on the surgical outcome ; it is better to compare the two groups with one similar surgical technique and approach . for example , a comparison between the results of surgical treatment of csr and csm in the patients treated with anterior cervical discectomy and fusion .   in conclusion , surgery was associated with an improvement in the neck disability index in the both groups ( p < 0.001 ) . regarding the improved ndi and patient 's satisfaction score , functional results in both groups were similar and comparable .
background . 
 cervical spondylosis can cause three different categories of symptoms and signs with possible overlap in the affected patients . 
 aim . 
 we aim to compare functional outcome of surgery in the patients with cervical spondylotic radiculopathy and myelopathy , regardless of their surgical type and approach . 
 materials and methods . 
 we retrospectively reviewed 140 patients with cervical spondylotic radiculopathy and myelopathy who had been operated from august 2006 to january 2011 , as group a ( 68 cases ) and group b ( 72 cases ) , respectively . 
 the mean age was 48.2 and 55.7 years , while the mean followup was 38.9 and 37.3 months , respectively . 
 functional outcome of the patients was assessed by neck disability index ( ndi ) and patient satisfaction with surgery . 
 results . only in group 
 a , the longer delay caused a worse surgical outcome ( ndi ) . 
 in addition , in group b , there was no significant relationship between imaging signal change of the spinal cord and our surgical outcomes . 
 improvement in ndi and final satisfaction rate in both groups are comparable . conclusions . 
 surgery was associated with an improvement in ndi in both groups ( p < 0.001 ) . 
 the functional results in both groups were similar and comparable , regarding this index and patient 's satisfaction score .