Change in Function, Pain and Quality of Life following Structured Nonoperative Treatment in Patients with Degenerative Cervical Myelopathy: A Systematic Review

Study Design: Systematic review. Objectives: The objective of this study was to conduct a systematic review to determine (1) change in function, pain, and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) variability of change in function, pain, and quality of life following different types of structured nonoperative treatment; (3) differences in outcomes observed between certain subgroups (eg, baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Methods: A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950, and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing, and/or traction. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results: Of the 570 retrieved citations, 8 met inclusion criteria and were summarized in this review. Based on our results, there is very low evidence to suggest that structured nonoperative treatment for DCM results in either a positive or negative change in function as evaluated by the Japanese Orthopaedic Association score. Conclusion: There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in function following structured nonoperative treatment. Furthermore, 23% to 54% of patients managed nonoperatively subsequently underwent surgical treatment.

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Determinants of quality of life in degenerative cervical myelopathy: a systematic review

British Journal of Neurosurgery ◽

10.1080/02688697.2021.1999390 ◽

2021 ◽

pp. 1-11

Author(s):

Yuri Hirayama ◽

Oliver D. Mowforth ◽

Benjamin M. Davies ◽

Mark R. N. Kotter

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Cervical Myelopathy ◽

Degenerative Cervical Myelopathy

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Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568217710137 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 53S-69S ◽

Cited By ~ 21

Author(s):

Michael G. Fehlings ◽

Lindsay A. Tetreault ◽

Shekar Kurpad ◽

Darrel S. Brodke ◽

Jefferson R. Wilson ◽

...

Keyword(s):

Systematic Review ◽

Operative Treatment ◽

Functional Impairment ◽

Cervical Myelopathy ◽

Surgical Intervention ◽

Japanese Orthopaedic Association ◽

Duration Of Symptoms ◽

Degenerative Cervical Myelopathy ◽

The Impact

Study Design: Systematic review. Objectives: The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. Methods: A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results: Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). Conclusion: Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.

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Machine learning algorithms for prediction of health-related quality-of-life after surgery for mild degenerative cervical myelopathy

The Spine Journal ◽

10.1016/j.spinee.2020.02.003 ◽

2020 ◽

Cited By ~ 3

Author(s):

Omar Khan ◽

Jetan H. Badhiwala ◽

Christopher D. Witiw ◽

Jefferson R. Wilson ◽

Michael G. Fehlings

Keyword(s):

Quality Of Life ◽

Machine Learning ◽

Cervical Myelopathy ◽

Learning Algorithms ◽

Machine Learning Algorithms ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Degenerative Cervical Myelopathy

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The Impact of Older Age on Functional Recovery and Quality of Life Outcomes after Surgical Decompression for Degenerative Cervical Myelopathy: Results from an Ambispective, Propensity-Matched Analysis from the CSM-NA and CSM-I International, Multi-Center Studies

Journal of Clinical Medicine ◽

10.3390/jcm8101708 ◽

2019 ◽

Vol 8 (10) ◽

pp. 1708 ◽

Cited By ~ 3

Author(s):

Jamie R. F. Wilson ◽

Jetan H. Badhiwala ◽

Fan Jiang ◽

Jefferson R. Wilson ◽

Branko Kopjar ◽

...

Keyword(s):

Quality Of Life ◽

Adverse Events ◽

Cervical Myelopathy ◽

Neck Disability Index ◽

Older Age ◽

Functional Improvement ◽

Increased Risk ◽

Degenerative Cervical Myelopathy ◽

The Impact

Background: The effect on functional and quality of life (QOL) outcomes of surgery in elderly degenerative cervical myelopathy (DCM) patients has not been definitively established. Objective: To evaluate the effect of older age on the functional and QOL outcomes after surgery in an international, multi-center cohort of patients with DCM. Methods: 107 patients aged over 70 years old (mean 75.6 ± 4.4 years) were enrolled in the AOSpine CSM-North America and International studies. A propensity-matched cohort of 107 patients was generated from the remaining 650 adults aged <70 years old (mean 56.3 ± 9.6 years), matched to gender, complexity of surgery, co-morbidities, and baseline functional impairment (modified Japanese Orthopedic Association scale (mJOA). Functional, disability, and QOL outcomes were compared at baseline and at two years post-operatively, along with peri-operative adverse events. Results: Both cohorts were equivalently matched. At two years, both cohorts showed significant functional improvement from the baseline but the magnitude was greater in the younger cohort (mJOA 3.8 (3.2–4.4) vs. 2.6 (2.0–3.3); p = 0.007). This difference between groups was also observed in the SF-36 physical component summary (PCS) and mental component summary (MCS) outcomes (p = <0.001, p = 0.007), but not present in the neck disability index (NDI) scores (p = 0.094). Adverse events were non-significantly higher in the elderly cohort (22.4% vs. 15%; p = 0.161). Conclusions: Elderly patients showed an improvement in functional and QOL outcomes after surgery for DCM, but the magnitude of improvement was less when compared to the matched younger adult cohort. An age over 70 was not associated with an increased risk of adverse events.

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Impact of Depression and Bipolar Disorders on Functional and Quality of Life Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy

Spine ◽

10.1097/brs.0000000000001777 ◽

2017 ◽

Vol 42 (6) ◽

pp. 372-378 ◽

Cited By ~ 17

Author(s):

Lindsay Tetreault ◽

Narihito Nagoshi ◽

Hiroaki Nakashima ◽

Anoushka Singh ◽

Branko Kopjar ◽

...

Keyword(s):

Quality Of Life ◽

Cervical Myelopathy ◽

Bipolar Disorders ◽

Life Outcomes ◽

Quality Of Life Outcomes ◽

Degenerative Cervical Myelopathy

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A Systematic Review of Definitions for Dysphagia and Dysphonia in Patients Treated Surgically for Degenerative Cervical Myelopathy

Global Spine Journal ◽

10.1177/21925682211035714 ◽

2021 ◽

pp. 219256822110357

Author(s):

Lindsay Tetreault ◽

Stefan F. Lange ◽

Silky Chotai ◽

Mercedes Lupo ◽

Michael T. Kryshtalskyj ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Cervical Myelopathy ◽

Sound Production ◽

Rating Scale ◽

Perioperative Complications ◽

Life Questionnaire ◽

Patient Reported ◽

Degenerative Cervical Myelopathy

Study Design: Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the literature and (2) assess the quality of definitions using a novel 4-point rating system. Methods: An electronic database search was conducted for studies that reported on dysphagia, dysphonia or other related complications of DCM surgery. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A 4-point rating scale was developed to assess the quality of definitions for each complication. Results: Our search yielded 2,673 unique citations, 11 of which met eligibility criteria and were summarized in this review. Defined complications included odynophagia (n = 1), dysphagia (n = 11), dysphonia (n = 2), perioperative swelling complications (n = 2), and soft tissue swelling (n = 3). Rates of dysphagia varied substantially (0.0%-50.0%) depending on whether this complication was patient-reported (4.4%); patient-reported using a modified Swallowing Quality of Life questionnaire (43.1%) or the Bazaz criteria (8.8%-50.0%); or diagnosed using an extensive protocol consisting of clinical assessment, a bedside swallowing test, evaluation by a speech and language pathologist and a modified barium swallowing test/fiberoptic endoscopy (42.9%). The reported incidences of dysphonia also ranged significantly from 0.6% to 38.0%. Conclusion: There is substantial variability in reported rates of dysphagia and dysphonia due to differences in data collection methods, diagnostic strategies, and definitions. Consolidation of nomenclature will improve evaluation of the overall safety of surgery.

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Functional and Quality of Life Outcomes of Surgery for Degenerative Cervical Myelopathy: a Quality Improvement Study

Journal of Orthopedic and Spine Trauma ◽

10.18502/jost.v4i2.2956 ◽

2020 ◽

Author(s):

Babak Mirzashahi ◽

Pejman Mansouri ◽

Arvin Najafi ◽

Saeed Besharati ◽

Mohammad Taha Kouchakinejad ◽

...

Keyword(s):

Quality Of Life ◽

Cervical Myelopathy ◽

Short Form ◽

Sf 36 ◽

Patient Reported ◽

Vas Scores ◽

One Year ◽

Degenerative Cervical Myelopathy

Background: This study aimed to determine the outcome of surgical treatments in patients with degenerative cervical myelopathy (DCM). During one-year follow-up period, we evaluated patient-reported functional and quality of life (QOL) measures. Methods: In a retrospective single-center study, we collected data of patients with DCM who underwent cervical fusion surgeries in Imam Khomeini Hospital, Tehran, Iran, from 2011 to 2015. Patients underwent single or multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or posterior laminectomy and fusion. We utilized patient-reported assessments including Short Form 36 (SF-36), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Nurick grade. Follow-up was performed at 6 weeks, 3 months, 6 months, and 12 months post-operatively to assess the outcome of surgery. Results: Ninety patients (56 men, 34 women) with a mean age of 54.1 (27-87) years were included. Comparison of pre- and post-operative scores showed significant improvement in SF-36 parameters, VAS, NDI, and Nurick grade (P < 0.001). Also, women’s VAS scores improved more than men's VAS scores during the follow-up period (P < 0.050). Age and type of surgery did not significantly affect the SF-36 parameters, VAS, NDI, and Nurick grade (P > 0.05). Conclusions: Cervical surgeries in patients with different severity of DCM can improve different aspects of QOL during one-year after surgery

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