Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database

OBJECTIVE Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors’ objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes. METHODS Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes. RESULTS In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05). CONCLUSIONS Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.

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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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Surgical management of bronchopulmonary carcinoids: A single center experience

South Asian Journal of Cancer ◽

10.4103/2278-330x.202568 ◽

2017 ◽

Vol 06 (01) ◽

pp. 006-010 ◽

Cited By ~ 1

Author(s):

Ashish Jakhetiya ◽

Pankaj Kumar Garg ◽

Rambha Pandey ◽

Palaniappan Ramanathan ◽

Sunil Kumar ◽

...

Keyword(s):

Surgical Treatment ◽

Histopathological Examination ◽

Postoperative Mortality ◽

North India ◽

Biological Behavior ◽

Long Term Results ◽

Surgical Approaches ◽

Delayed Presentation ◽

Duration Of Symptoms ◽

Tertiary Teaching

Abstract Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

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Comparison of Laminoplasty and Posterior Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

10.21203/rs.3.rs-478135/v1 ◽

2021 ◽

Author(s):

Hiroaki Nakashima ◽

Shiro Imagama ◽

Toshitaka Yoshii ◽

Satoru Egawa ◽

Kenichiro Sakai ◽

...

Keyword(s):

Cervical Myelopathy ◽

Perioperative Complications ◽

Clinical Status ◽

Japanese Orthopaedic Association ◽

Posterior Longitudinal Ligament ◽

Posterior Fusion ◽

Postoperative Outcomes ◽

Intensity Change ◽

Multivariable Logistic Regression Analysis ◽

Significant Difference

Abstract This prospective multicenter study formed by the Japanese Ministry of Health, Labour and Welfare at 27 institutions aimed to compare postoperative outcomes between laminoplasty (LM) and posterior fusion (PF) for cervical ossification of the posterior longitudinal ligament (OPLL). Controversy exists regarding the role of instrumented fusion in the context of posterior surgical decompression for OPLL. Among the 479 patients enrolled, 189 (137 and 52 patients with LM and PF, respectively) were included and evaluated using the Japanese Orthopaedic Association (JOA) scores, the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and radiographical measurements. Basic demographic and radiographical data were reviewed, and the propensity to choose a surgical procedure was calculated. Preoperatively, patient backgrounds, radiographical measurements (K-line or cervical alignment on X-ray, OPLL occupation ratio on computed tomography, and increased signal intensity change on magnetic resonance imaging), or clinical status (JOA score and JOACMEQ) after adjustments showed no significant differences. The overall risk of perioperative complications was lower in LM (odds ratio [OR] 0.40, p = 0.006), and C5 palsy was significantly lower in LM (OR 0.11, p = 0.0002) than in PF. The range of motion (20.91° ± 1.05° and 9.38° ± 1.24°, p < 0.0001) in patients with PF was significantly smaller than in those with LM. However, multivariable logistic regression analysis showed no significant difference in JOA score, JOA recovery rate, or JOACMEQ improvement at two years. In contrast, OPLL progression was greater in LM group than in the PF group (OR 2.73, p = 0.0002). LM and PF for cervical myelopathy due to OPLL resulted in comparable postoperative outcomes at two years after surgery.

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A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression

Global Spine Journal ◽

10.1177/2192568217701914 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 70S-83S ◽

Cited By ~ 75

Author(s):

Michael G. Fehlings ◽

Lindsay A. Tetreault ◽

K. Daniel Riew ◽

James W. Middleton ◽

Bizhan Aarabi ◽

...

Keyword(s):

Cervical Myelopathy ◽

Surgical Intervention ◽

Guideline Development ◽

Cord Compression ◽

Operative Intervention ◽

Prophylactic Surgery ◽

Cervical Cord ◽

Duration Of Symptoms ◽

Degenerative Cervical Myelopathy ◽

The Impact

Study Design: Guideline development. Objectives: The objective of this study is to develop guidelines that outline how to best manage (1) patients with mild, moderate, and severe myelopathy and (2) nonmyelopathic patients with evidence of cord compression with or without clinical symptoms of radiculopathy. Methods: Five systematic reviews of the literature were conducted to synthesize evidence on disease natural history; risk factors of disease progression; the efficacy, effectiveness, and safety of nonoperative and surgical management; the impact of preoperative duration of symptoms and myelopathy severity on treatment outcomes; and the frequency, timing, and predictors of symptom development. A multidisciplinary guideline development group used this information, and their clinical expertise, to develop recommendations for the management of degenerative cervical myelopathy (DCM). Results: Our recommendations were as follows: (1) “We recommend surgical intervention for patients with moderate and severe DCM.” (2) “We suggest offering surgical intervention or a supervised trial of structured rehabilitation for patients with mild DCM. If initial nonoperative management is pursued, we recommend operative intervention if there is neurological deterioration and suggest operative intervention if the patient fails to improve.” (3) “We suggest not offering prophylactic surgery for non-myelopathic patients with evidence of cervical cord compression without signs or symptoms of radiculopathy. We suggest that these patients be counseled as to potential risks of progression, educated about relevant signs and symptoms of myelopathy, and be followed clinically.” (4) “Non-myelopathic patients with cord compression and clinical evidence of radiculopathy with or without electrophysiological confirmation are at a higher risk of developing myelopathy and should be counselled about this risk. We suggest offering either surgical intervention or nonoperative treatment consisting of close serial follow-up or a supervised trial of structured rehabilitation. In the event of myelopathic development, the patient should be managed according to the recommendations above.” Conclusions: These guidelines will promote standardization of care for patients with DCM, decrease the heterogeneity of management strategies and encourage clinicians to make evidence-informed decisions.

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Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Neurosurgical FOCUS ◽

10.3171/2016.3.focus1665 ◽

2016 ◽

Vol 40 (6) ◽

pp. E14 ◽

Cited By ~ 23

Author(s):

Lindsay Tetreault ◽

Jefferson R. Wilson ◽

Mark R. N. Kotter ◽

Aria Nouri ◽

Pierre Côté ◽

...

Keyword(s):

Relative Risk ◽

Cervical Myelopathy ◽

Univariate Analysis ◽

Japanese Orthopaedic Association ◽

Minimum Clinically Important Difference ◽

Duration Of Symptoms ◽

Clinically Important Difference ◽

Younger Age ◽

Degenerative Cervical Myelopathy ◽

Unstable Gait

OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower-limb spasticity, and broad-based unstable gait. The final model included age (relative risk [RR] 0.924, p < 0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS In this large multinational prospective cohort, 70% of patients treated surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The key predictors of achieving an MCID on the mJOA scale were younger age, shorter duration of symptoms, nonsmoking status, and lack of significant gait impairment.

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Provision and Perception of Physiotherapy in the Nonoperative Management of Degenerative Cervical Myelopathy (DCM): A Cross-Sectional Questionnaire of People Living With DCM

Global Spine Journal ◽

10.1177/2192568220961357 ◽

2020 ◽

pp. 219256822096135

Author(s):

Max B. Butler ◽

Oliver D. Mowforth ◽

Abdul Badran ◽

Michelle Starkey ◽

Timothy Boerger ◽

...

Keyword(s):

Cervical Myelopathy ◽

Nonoperative Management ◽

Japanese Orthopaedic Association ◽

Multivariate Logistic Regression Analysis ◽

Demographic Characteristics ◽

Symptom Duration ◽

Cross Sectional Survey ◽

Cross Sectional ◽

International Guidelines ◽

Degenerative Cervical Myelopathy

Study Design: Cross-sectional survey. Objectives: Degenerative cervical myelopathy (DCM) is a common syndrome of acquired spinal cord impairment caused by canal stenosis secondary to arthritic changes of the spine. International guidelines consider physiotherapy an option for mild, stable DCM; however, few studies have been conducted on nonoperative management. The objective was to determine current usage and perceptions of nonoperative physiotherapy for DCM. Methods: Persons with DCM were recruited to a web-based survey. Participants with complete responses that had not received surgery were included (n = 167). Variables included symptom duration, treatment history, current disability, and demographic characteristics. Results: Disease and demographic characteristics were equivalent between those who did and did not receive physiotherapy. In all, 19.5% of physiotherapy recipients reported subjective benefit from physiotherapy. Those perceiving benefit had significantly higher mJOA (modified Japanese Orthopaedic Association) scores, lower neck pain scores, and shorter symptom duration. In multivariate logistic regression analysis, those with mild DCM were more likely to perceive benefit than those with severe DCM, as were those with moderate DCM (to a lesser extent). Individuals whose diagnosis was delayed 1 to 2 years were less likely to perceive benefit than those that waited 0 to 6 months. Conclusions: The provision of nonoperative physiotherapy in the management of DCM is inconsistent and appears to differ from international guidelines. Few patients perceived benefit from physiotherapy; however, this was more likely in those with mild DCM and in those with shorter symptom durations. Further work is needed to establish the appropriate role of physiotherapy for this population.

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Factors associated with delay to pituitary adenoma diagnosis in patients with visual loss

Journal of Neurosurgery ◽

10.3171/2011.6.jns101663 ◽

2012 ◽

Vol 116 (2) ◽

pp. 283-289 ◽

Cited By ~ 17

Author(s):

Arman Jahangiri ◽

Kathleen R. Lamborn ◽

Lewis Blevins ◽

Sandeep Kunwar ◽

Manish K. Aghi

Keyword(s):

Pituitary Adenoma ◽

Visually Impaired ◽

Symptom Duration ◽

Delayed Presentation ◽

Medical Provider ◽

Duration Of Symptoms ◽

Emergency Department Admission ◽

Factors Associated ◽

Visual Symptoms ◽

Age Range

Object The duration of visual symptoms associated with a nonfunctioning pituitary adenoma (NFA) is a predictive factor for chances of visual improvement. The authors investigated factors associated with increased duration of visual symptoms in patients with NFAs. Methods The authors retrospectively reviewed NFAs resected at their institution between 2004 and 2010 for duration of visual symptoms, postoperative improvement, and associated factors. Results Seventy-five patients underwent NFA resection with a median visual symptom duration of 6.5 months (range 1 week–15 years). A multivariate logistic regression showed that duration of symptoms (p = 0.04), but not age at surgery (p = 0.2), predicted postoperative normalization of vision. Univariate nonparametric analyses investigating age at symptom onset, sex, race, insurance type, ophthalmological conditions, income, marital status, emergency department admission, language, and medical provider found that age was the only variable significantly prolonging symptom duration (p = 0.04), a finding confirmed by a multivariate regression analysis. Patients 20–39, 40–59, and 60–79 years old had median durations of symptoms of 4, 7, and 9 months, respectively. Seven older patients had symptoms attributed to preexisting ophthalmological conditions for a median of 18 months before NFA diagnosis. Among age and race subgroups, the largest difference in median symptom duration was between white patients in the 60–79-year age range (duration of 5 months) and nonwhite patients in the 60–79-year age range (duration of 24 months) (p = 0.04). Conclusions The authors found that older age was associated with delayed NFA diagnosis in visually impaired patients. Contributing factors were the attributing of visual symptoms from NFAs to other ophthalmological conditions in these patients, and delayed presentation in elderly nonwhite patients. These findings highlight challenges associated with timely NFA diagnosis in visually impaired patients, a key factor for chances of improvement.

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Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term benefit

Neurosurgical FOCUS ◽

10.3171/2016.6.focus16146 ◽

2016 ◽

Vol 41 (3) ◽

pp. E2 ◽

Cited By ~ 8

Author(s):

Sharif Vakili ◽

Dane Moran ◽

Alice Hung ◽

Benjamin D. Elder ◽

Lee Jeon ◽

...

Keyword(s):

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Postoperative Outcomes ◽

Urinary Continence ◽

Symptom Duration ◽

Short Term ◽

Duration Of Symptoms ◽

Cognitive Improvement

OBJECTIVE A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. METHODS The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: gait performance, urinary continence, and cognition. RESULTS The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60–70 years, and lack of cognitive improvement in patients aged 70–80 years. CONCLUSIONS Patients with iNPH with longer duration of preoperative symptoms may not receive the same short-term benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.

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DEMOGRAPHICS OF PEDIATRIC AND ADOLESCENT PATIENTS WITH DISCOID MENISCI

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00152 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0015

Author(s):

Nirav K. Pandya ◽

Sean P. Robinson ◽

Jarrad Merriman

Keyword(s):

Range Of Motion ◽

Short Duration ◽

Surgical Intervention ◽

Cartilage Damage ◽

Meniscal Repair ◽

Symptom Duration ◽

Duration Of Symptoms ◽

Sport Training ◽

Adolescent Patients ◽

Operative Findings

BACKGROUND There has been an increase in the understanding of meniscus tears in pediatric and adolescent patients particularly with the rise of intensive sport training in this age group. Yet, discoid menisci represent a congenital entity for which there exists controversy as to the optimal workup, treatment, and long-term outcomes. Although there have been multiple reports on the surgical treatment of these patients, there is limited examination of these patient’s demographic characteristics and presentation. The purpose of this study is to define the demographics, presentation, and treatment patterns of discoid menisci in a single surgeon’s patient cohort METHODS We performed a retrospective review of all discoid meniscus patients from a single institution from 2012 to 2017. Demographics, history and physical examination notes, and intra-operative findings were reviewed. RESULTS Eighty-one patients were identified. Patients identifying as Hispanic (38%) and Caucasian (23%) made up the most common ethnic group. The average age at the time of presentation was 12.5 years old. Ninety-eight percent of patients reported pain upon presentation; however, this was commonly in conjunction with other symptoms. Most patients (48%) reported only short duration of symptoms (0 to 3 months) prior to presentation. In about one half of patients, tears were identified in 44 (54%) patients, and nearly 2/3 of patients (52) elected to undergo surgical intervention. Patients undergoing operative intervention had a high proportion of range of motion deficits (69% v 17%, p<0.001), meniscal tears (77% v 17%, p<0.001) and cartilage damage (33% v 3%, p=0.002). Nearly 2/3 of patients who required intervention necessitate meniscal repair with or without concomitant cartilage procedures. CONCLUSIONS / SIGNIFICANCE Unlike prior studies, the vast majority of patients with discoid menisci in our population were Hispanic or Caucasian. Although congenital, the vast majority of patients presented with a short duration of complaints (less than 6 months) in the second decade of life. A complex constellation of symptoms was present with isolated knee pain seen less commonly as well as athletic participation. Loss of range of motion drives surgical intervention with meniscal repair being more commonly performed regardless of symptom duration as opposed to saucerization. Nearly 1/3 of patients demonstrated cartilage damage intra-operatively; demonstrating the need for surgeons to not only counsel patients pre-operatively but also be prepared to repair and/or treat cartilage rather than perform saucerization.

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Trajectory of Improvement in Myelopathic Symptoms From 3 to 12 Months Following Surgery for Degenerative Cervical Myelopathy

Neurosurgery ◽

10.1093/neuros/nyz325 ◽

2019 ◽

Vol 86 (6) ◽

pp. 763-768

Author(s):

Inamullah Khan ◽

Kristin R Archer ◽

John Paul Wanner ◽

Mohamad Bydon ◽

Jacquelyn S Pennings ◽

...

Keyword(s):

Cervical Myelopathy ◽

Elective Surgery ◽

Japanese Orthopaedic Association ◽

Cord Compression ◽

Cervical Cord ◽

Multivariable Logistic Regression Model ◽

Quality Outcomes ◽

Degenerative Cervical Myelopathy ◽

Postoperative Improvement

Abstract BACKGROUND Degenerative cervical myelopathy (DCM) is a progressive disease resulting from cervical cord compression. The modified Japanese Orthopaedic Association (mJOA) is commonly used to grade myelopathic symptoms, but its persistent postoperative improvement has not been previously explored. OBJECTIVE To utilize the Quality Outcomes Database (QOD) to evaluate the trajectory of outcomes in those operatively treated for DCM. METHODS This study is a retrospective analysis of prospectively collected data. The QOD was queried for patients undergoing elective surgery for DCM. Patients were divided into mild (≥14), moderate (9-13), or severe (<9) categories for their baseline severity of myelopathic symptoms (mJOA scores). A parsimonious multivariable logistic regression model was fitted with 2 points improvement on mJOA from 3- to 12-mo follow-up as the outcome of interest. RESULTS A total of 2156 patients who underwent elective surgery for DCM and had complete 3- and 12-mo follow-up were included in our analysis. Patients improved significantly from baseline to 3-mo on their mJOA scores, regardless of their baseline mJOA severity. After adjusting for the relevant preoperative characteristics, the baseline mJOA categories had significant impact on outcome of whether a patient keeps improving in mJOA score from 3 to 12 mo postsurgery. Patient with severe mJOA score at baseline had a higher likelihood of improvement in their myelopathic symptoms, compared to patients with mild mJOA score in. CONCLUSION Most patients achieve improvement on a shorter follow-up; however, patients with severe symptoms keep on improving until after a longer follow-up. Preoperative identification of such patients helps the clinician settling realistic expectations for each follow-up timepoint.

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