Trajectory of Improvement in Myelopathic Symptoms From 3 to 12 Months Following Surgery for Degenerative Cervical Myelopathy. Neurosurgery 2020 Jun 01;86(6):763-768
Date
08/23/2019Pubmed ID
31435676DOI
10.1093/neuros/nyz325Scopus ID
2-s2.0-85088607013 (requires institutional sign-in at Scopus site) 17 CitationsAbstract
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.
Author List
Khan I, Archer KR, Wanner JP, Bydon M, Pennings JS, Sivaganesan A, Knightly JJ, Foley KT, Bisson EF, Shaffrey C, McGirt MJ, Asher AL, Devin CJ, QOD Vanguard SitesAuthor
John P. Wanner MD Assistant Professor in the Orthopaedic Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Cervical Vertebrae
Decompression, Surgical
Elective Surgical Procedures
Female
Follow-Up Studies
Humans
Male
Middle Aged
Prospective Studies
Registries
Retrospective Studies
Spinal Cord Compression
Spinal Cord Diseases
Time Factors
Treatment Outcome