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Neurogenic Bladder Associated With Pure Cervical Spondylotic Myelopathy: Clinical Characteristics and Recovery After Surgery

Fukuda, Koji, MD*; Ozaki, Takuma, MD*; Tsumura, Nobuhiro, MD*; Sengoku, Atsushi, MD; Nomi, Masashi, MD; Yanagiuchi, Akihiro, MD; Nishida, Kotaro, MD; Kuroda, Ryosuke, MD; Iguchi, Tetsuhiro, MD§

doi: 10.1097/BRS.0b013e318267af02
Cervical Spine

Study Design. Retrospective study.

Objective. To examine the prevalence of lower urinary tract symptoms (LUTS) and neurogenic bladder (NB), and surgical outcomes in pure cervical spondylotic myelopathy.

Summary of Background Data. The inclusion of various types of cervical diseases, NB, and no obvious definition of NB provided the wide range of NB prevalence frequency among previous reports.

Methods. Of the 220 operated patients with cervical myelopathy, 54 were selected by excluding other cervical and/or concomitant diseases contributing to LUTS. All patients with LUTS were referred to urologists and recommended to undergo urodynamic study (UDS). The presence of NB was judged by abnormal findings of UDS according to the most recent criteria and a congruity between LUTS and the course of cervical myelopathy. Patients were divided into 4 groups: no symptoms, positive symptoms without UDS examination, positive symptoms with positive NB, and positive symptoms with negative NB. Evaluation scores were compared among the groups before and after surgery.

Results. There were no particular LUTS in NB patients. Prevalence of LUTS was 53.7% and that of NB was at least 20.4% in the patients with pure cervical spondylotic myelopathy. The scores of all 4 groups improved after surgery (P < 0.05); however, the recovery rate of NB group (47.1%) was the worst among the groups (no-symptoms group, 69.3%; negative-NB group, 53.5%; and positive symptoms without UDS group, 57.1%). Preoperative part scores showed no difference among the groups, whereas NB group demonstrated lower scores in finger and lower extremity postoperatively. A post hoc analysis confirmed a significantly poorer recovery rate related to the NB group only in the lower extremities.

Conclusion. This study is the first to describe the prevalence of LUTS and NB according to the most recent criteria in patients with pure cervical spondylotic myelopathy, which demonstrated that neurological functions in NB patients may recover; however, the extent will be limited to two-thirds of those in patients with no-NB; moreover, the remaining symptoms derive from poor lower limb function.

Prevalence of lower urinary tract symptoms and neurogenic bladder was 53.7% and at least 20.4%, respectively, in patients with pure cervical spondylotic myelopathy (CSM). The presence of neurogenic bladder in CSM patients was closely related to poor recovery in the lower extremity motor function.

*Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan

Department of Urology, Hyogo Rehabilitation Center Hospital, Kobe, Japan

Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; and

§Department of Rehabilitation Science, Kobe University Graduate School of Medicine in Hyogo Rehabilitation Center, Kobe, Japan.

Address correspondence and reprint requests to Takuma Ozaki, MD, 1070 Akebono-Cho, Nishi-Ku, Kobe, 651-2181 Japan; E-mail:

Acknowledgment date: January 5, 2012. Revision date: May 20, 2012. Acceptance date: July 2, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2013 Lippincott Williams & Wilkins, Inc.