How Is Spinal Cord Function Measured in Degenerative Cervical Myelopathy? A Systematic Review

Abstract

Degenerative cervical myelopathy (DCM) is a prevalent condition in which spinal degeneration causes cord compression and neurological dysfunction. The spinal cord is anatomically complex and operates in conjunction with the brain, the musculoskeletal system, and numerous organs to control numerous functions, including simple and coordinated movement, sensation, and autonomic functions. As a result, accurate and comprehensive measurement of spinal cord function in patients with DCM and other spinal pathologies is challenging. This project aimed to summarize the neurological, functional, and quality of life (QoL) outcome measures currently in use to quantify impairment in DCM. A systematic review of the literature was performed to identify prospective studies with at least 100 DCM subjects that utilized one or more quantitative neurological, functional, or QoL outcome measures. A total of 148 studies were identified. The most commonly used instruments were subjective functional scales including the Japanese Orthopedic Association (JOA) (71 studies), modified JOA (mJOA) (66 studies), Neck Disability Index (NDI) (54 studies), and Nurick (39 studies), in addition to the QoL measure Short-Form-36 (SF-36, 52 studies). A total of 92% (320/349) of all outcome measures were questionnaires, whereas objective physical testing of neurological function (strength, gait, balance, dexterity, or sensation) made up 8% (29/349). Studies utilized an average of 2.36 outcomes measures, while 58 studies (39%) utilized only a single outcome measure. No studies were identified that specifically assessed the dorsal column sensory pathway or respiratory, bowel, or sexual function. In the past five years, there were no significant differences in the number of total, functional, or QoL outcome measures used, but physical testing of neurological function has increased (p = 0.005). Prior to 2017, cervical spondylotic myelopathy (CSM) was the most frequently used term to describe the study population, whereas in the last five years, DCM has become the preferred terminology. In conclusion, clinical studies of DCM typically utilize limited data to characterize impairment, often relying on subjective, simplistic, and non-specific measures that do not reflect the complexity of the spinal cord. Although accurate measurement of impairment in DCM is challenging, it is necessary for early diagnosis, monitoring for deterioration, and quantifying recovery after therapeutic interventions. Clinical decision-making and future clinical studies in DCM should employ a combination of subjective and objective assessments to capture the multitude of spinal cord functions to improve clinical management and inform practice guidelines.

Translation, adaptation and validation of a Spanish version of the Japanese orthopaedic association cervical myelopathy questionnaire

“…There is still a lack of consensus on how to assess DCM patients, which questionnaires to use, and what heterogeneous outcome measures are available across the globe. This heterogeneity leads to publication bias, hampering interstudy comparison and guideline creation 15,16 . This has motivated recent interest in developing a core measurement set for DCM 9,17,18 and the recommendations to use a set of multiple subjective and objective measures 17 …”

“…This heterogeneity leads to publication bias, hampering interstudy comparison and guideline creation. 15,16 This has motivated recent interest in developing a core measurement set for DCM 9,17,18 and the recommendations to use a set of multiple subjective and objective measures. 17 The JOACMEQ questionnaire is the first DCM-specific questionnaire that attempts to jointly assess neurological function, disability, and QoL associated with.…”

Effect of cervical suspensory traction in the treatment of severe cervical kyphotic deformity

“…31 patients had cervical myelopathy, 10 had radicular symptoms in addition to myelopathy. Clinical outcomes were assessed using the mJOA score (10), visual analog scale (VAS), and Neck Disability Index (NDI).…”

Degenerative Cervical Myelopathy and Spinal Cord Injury: Introduction to the Special Issue

“…Traditionally, physician administered outcome measures such as mJOA and Nurick, and patient reported NDI, have been used to classify DCM severity, while tSCI studies typically report ASIA Impairment Scale (AIS) and the ISNCSCI, which includes high reliability and objective interpretation of findings. However, the ISNCSCI is not sensitive to subtle SC dysfunction such as hand incoordination or gait imbalance, which are subjectively captured by DCM outcome measures (e.g., mJOA) [ 4 ]. Both pathologies impair patients’ mobility, strength, and coordination, significantly affecting patients’ quality of life, resulting in a significant healthcare burden as the leading cause of SC dysfunction.…”

“…Recognizing the limitations and variability of current outcome measures utilized to study DCM, Soufi et al [ 4 ], assessed the number, quality, and variety of outcome measures currently used in the literature through a systematic review on 148 studies. A total of 39% percent of studies utilized single outcome measures with an average of 2.36 outcome measures used in the studies, with no studies specifically assessing key functions including dorsal column sensory pathway or respiratory, bowel, and sexual function.…”