Composite Grip Strength as a Marker of Outcome in Patients Surgically Treated for Degenerative Cervical Myelopathy

Abstract

This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy. Overview of Literature: Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention. Methods: This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre-and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score. Results: A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores. Conclusions: Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

Difference between Anterior and Posterior Cord Compression and Its Clinical Implication in Patients with Degenerative Cervical Myelopathy

“…Degenerative cervical myelopathy (DCM) is mainly characterized by motor dysfunctions, such as hand clumsiness, gait disturbance, and/or bladder and bowel dysfunction [ 1 ]. In general, the severity of these neurologic deficits is known to be associated with a low anteroposterior (A-P) compression ratio or flattening shape of the spinal cord.…”

Improving Assessment of Disease Severity and Strategies for Monitoring Progression in Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 4]

“…There are also computerized systems that evaluate isometric pinch and grip strength and provide further information on the motor function of the hand. 86 These tools have been used in other conditions such as rheumatoid arthritis, stroke and brachial plexus injury. 87 - 89 Certain measurements include maximum grip strength, sustained grip strength (force exerted over the final 3 seconds of a 5 second test), three-jaw pinch strength (index and middle finger on one side and thumb on the other side) and maximum key pinch (thumb on one side and the lateral side of the index finger on the other side while making a fist).…”

“… 87 - 89 Certain measurements include maximum grip strength, sustained grip strength (force exerted over the final 3 seconds of a 5 second test), three-jaw pinch strength (index and middle finger on one side and thumb on the other side) and maximum key pinch (thumb on one side and the lateral side of the index finger on the other side while making a fist). 86 The grip dynamometer and computerized grip strength systems are easy to use and provide objective data on hand function.…”