Clinical indicators of surgical outcomes after cervical single open-door laminoplasty assessed by the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Abstract

Study design Retrospective cohort study. Objectives The old-version JOA score for cervical myelopathy (CM) is an evaluation system performed by medical providers that focuses only on neurological function. The purpose of this study was to evaluate patient-reported outcomes using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), and to clarify clinical factors that affect the therapeutic effectiveness for CM. Setting Single institute in Japan. Methods We reviewed surgical outcomes for 126 CM patients who were treated by single open-door laminoplasty and were followed at least 2 years. We assessed clinical information, JOACMEQ, JOA scores, and radiographic parameters. Patients were grouped according to effective or ineffective surgical outcomes as defined by the JOACMEQ using logistic regression analyses. Results Laminoplasty resulted in functional improvement in the cervical spine and extremities for 40-50% of the patients, while bladder function showed only minimal recovery. Multivariable analyses revealed that a significant postoperative reduction in neck or shoulder pain influenced the effective functional recovery of the cervical spine. A reduction in arm or hand pain favorably affected the postoperative upper extremity function. Lower age and a postoperative decrease in limb pain were correlated with significantly improved function of the lower extremities. A postoperative reduction in arm pain enhanced the QOL recovery. Conclusions The JOACMEQ makes it possible to analyze multiple aspects of surgical outcomes for patients who undergo cervical spine surgery. Open-door laminoplasty did not provide favorable results for some patients, which highlights the importance of assessing the indications for this procedure and managing postoperative pain.

Posterior open-door laminoplasty secured with titanium miniplates vs anchors: a comparative study of clinical efficacy and cervical sagittal balance

“…Cervical degenerative disease is a major cause of spinal diseases, and its incidence has been rising in the elderly people [1–3]. Posterior open-door laminoplasty (PODL) is the primary treatment for multi-segmental cervical spondylotic myelopathy (MCSM), developmental cervical spinal canal stenosis, ossification of cervical posterior longitudinal ligament, and so on.…”

Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system

“…In enrolled patients, median duration of symptoms was 11 months [8][9][10][11][12][13] (p > 0.05). Presurgical MRI evaluation showed a significant difference between groups in length of the lesion on T2wi showing longer lesions in fair recovery group 12 mm [12][13][14][15][16] compared with 6 mm [3][4][5][6][7][8][9] in good recovery group (p < 0.001). Presurgical MEP between groups did not show a significant difference (p > 0.05).…”

“…Surgery is beneficial at a certain point of the disease in some patients [4,15]; however, there is not accordance about timing for surgery [9], and no test is validated to support clinician in decision-making process or in patients selection.…”

“…This study demonstrates that CSS taking into consideration neurologic, cervical MRI, and MEP results may be a feasible and helpful method to forecast postsurgical outcome and to guide clinical decision in CSM patients candidate to surgery. Further studies should be performed in subgroups of patients to assess whether, even if surgery could be less effective [15] in term of recovery, it might be beneficial in preventing progression of neurologic impairments.…”

Degenerative Cervical Myelopathy: A Review of Current Concepts

“…The prevalence of chronic pain and longer pain duration increases with age. [1][2][3][4][5] Myelopathy is a disorder that results from severe compression of the spinal cord. It is caused by a variety of conditions, including congenital stenosis, degenerative changes, rheumatoid arthritis, and trauma.…”