Correlation of quality of life and functional outcome measures for cervical spondylotic myelopathy

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Studies comparing surgical treatments for cervical spondylotic myelopathy (CSM) are heterogeneous, using a variety of different quality of life (QOL) outcomes and myelopathy-specific measures. This study sought to evaluate the relationship of these measures to each other, and to better understand their use in evaluating patients with CSM.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A retrospective study was performed in all patients with CSM who underwent either ventral or dorsal cervical spine surgery at a single tertiary-care institution between January 2008 and July 2013. Severity of myelopathy was assessed pre- and postoperatively using both the Nurick scale and the modified Japanese Orthopaedic Association (mJOA) classification of disability. Prospectively collected QOL outcomes data included Pain Disability Questionnaire (PDQ), Patient Health Questionnaire–9 (PHQ-9), and EQ-5D. Spearman rank correlations were calculated to assess the construct convergent validity for each pair of health status measures (HSMs). To assess each HSM’s ability to discriminate favorable EQ-5D index, we performed receiver operating characteristic (ROC) curve analysis and assessed the area under the curve (AUC).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 119 patients were included. The PDQ total score had the highest correlation with EQ-5D index (Spearman’s rho = −0.82). Neither of the myelopathy scales (mJOA or Nurick) had strong correlations between themselves (0.41) or with the other QOL measures (absolute value range 0.13–0.49). In contrast, the QOL measures correlated relatively well with each other (absolute value range 0.68–0.97). For predicting favorable EQ-5D outcomes, PDQ total score had an AUC of 0.909. The AUCs were significantly greater for the QOL measures in comparison with the myelopathy measures (AUCs were 0.677 and 0.607 for mJOA and Nurick scale scores, respectively).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The authors found that all included measures of QOL and CSM-specific (mJOA or Nurick scale) measures were valid and responsive. The PDQ was the most predictive of positive QOL after surgery (as measured by the EQ-5D index) for patients with CSM. The substantially lower correlation between myelopathy and QOL outcomes, compared with the various QOL measures themselves, suggests that these questionnaires are measuring different aspects of the patient experience. Solely assessing the myelopathy or disease-specific signs and symptoms is likely insufficient to fully understand and appreciate clinical outcome in its totality. These questionnaire types should be used together to best evaluate patients pre- and postoperatively.</jats:p></jats:sec>

Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes

“… 5 Solely assessing the myelopathy is likely insufficient to fully understand clinical outcome in its totality, and combinations of questionnaires are recommended. 38 , 44 , 45 A study comparing 7 different scales, including mJOA and EMS, found that all of them detected significant improvement following surgery. 46 Still, each scale had differing qualities of reliability, validity, and responsiveness.…”

The effect of positive changes during intraoperative monitoring of the functional improvement in patients with cervical compressive myelopathy

“… 1 CCM is characterized by spinal cord compression due to physiologic narrowing of the sagittal diameter of the spinal canal secondary to degenerative changes in the cervical spine. 2 Its clinical presentation includes numbness, weakness, neck pain, loss of dexterity, and problems with gait. 1 , 2 Recently, intraoperative monitoring (IOM) has been increasingly used to prevent neurological impairment during spinal cord surgery.…”

“… 2 Its clinical presentation includes numbness, weakness, neck pain, loss of dexterity, and problems with gait. 1 , 2 Recently, intraoperative monitoring (IOM) has been increasingly used to prevent neurological impairment during spinal cord surgery. 3 , 4 Changes during IOM are also associated with corresponding spinal cord functions during surgery.…”

A comparison of minimally invasive posterior cervical decompression and open anterior cervical decompression and instrumented fusion in the surgical management of degenerative cervical myelopathy

“…While widely reported in the literature, the mJOA is an investigator-administered tool, not a patientreported outcome, and may have poor discrimination in predicting clinical outcome from the perspective of the patient. 15,30 Prior work from our group suggests that the SF-12 Physical Component Summary (PCS) is more discriminatory than the mJOA and may be less affected by length of follow-up than other scores (B Yim, A Ata, JW German: Defining substantial clinical benefit in patients undergoing surgery for cervical spondylotic myelopathy. Presentation to the 2014 AANS Annual Meeting, San Francisco, California, April 5, 2014).…”

“…While in the past the documentation of improved clinical outcomes using patient-reported outcome has proved challenging, 14 more recent studies have reported improvements after spine surgery with patient-reported outcome measures. 2,3,6,8,11,15,[19][20][21]25,30 Some may argue that clinical outcome following surgery for DCM is best assessed by a disease-specific measure of neurological disability such as the modified Japanese Orthopaedic Association (mJOA) scale score. While widely reported in the literature, the mJOA is an investigator-administered tool, not a patientreported outcome, and may have poor discrimination in predicting clinical outcome from the perspective of the patient.…”