Improvement rates, adverse events and predictors of clinical outcome following surgery for degenerative cervical myelopathy

Abstract

Purpose To investigate improvement rates, adverse events and predictors of clinical outcome after laminectomy alone (LAM) or laminectomy with instrumented fusion (LAM + F) for degenerative cervical myelopathy (DCM). Methods This is a post hoc analysis of a previously published DCM cohort. Improvement rates for European myelopathy score (EMS) and Neck Disability Index (NDI) at 2- and 5-year follow-ups and adverse events are presented descriptively for available cases. Predictor endpoints were EMS and NDI scores at follow-ups, surgeon- and patient-reported complications, and reoperation-free interval. For predictors, univariate and multivariable models were fitted to imputed data. Results Mean age of patients (LAM n = 412; LAM + F n = 305) was 68 years, and 37.4% were women. LAM + F patients had more severe spondylolisthesis and less severe kyphosis at baseline, more surgeon-reported complications, more patient-reported complications, and more reoperations (p ≤ 0.05). After imputation, the overall EMS improvement rate was 43.8% at 2 years and 36.3% at 5 years. At follow-ups, worse EMS scores were independent predictors of worse EMS outcomes and older age and worse NDI scores were independent predictors of worse NDI outcomes. LAM + F was associated with more surgeon-reported complications (ratio 1.81; 95% CI 1.17–2.80; p = 0.008). More operated levels were associated with more patient-reported complications (ratio 1.12; 95% CI 1.02–1.22; p = 0.012) and a shorter reoperation-free interval (hazard ratio 1.30; 95% CI 1.08–1.58; p = 0.046). Conclusions These findings suggest that surgical intervention at an earlier myelopathy stage might be beneficial and that less invasive procedures are preferable in this patient population.

Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy

“…The potential benefits must be weighed against the risk of complications with spinal surgery. One prospective registry study identified a 15% incidence of adverse events in the first year following surgery ( de Dios et al, 2022 ). In our clinical experience, not all patients with mild DCM opt for surgery.…”

A single centre service evaluation of degenerative cervical and thoracic myelopathy

“…The time from onset of symptoms to diagnosis was significantly greater in DCM. Delayed diagnosis is a recognised problem in DCM that results in treatment delays [1,33]; this is particularly problematic given the fact that the best response to surgery may be seen after early intervention [34]. This observation does not preclude a similar problem of delayed and missed diagnoses in DTM.…”

A Comparison of Corpectomy ACDF Hybrid Procedures with Nano‐Hydroxyapatite/Polyamide 66 Cage and Titanium Mesh Cage for Multi‐level Degenerative Cervical Myelopathy: A Stepwise Propensity Score Matching Analysis

“…T he available medical literature has shown that surgical procedures can improve functional status and quality of life by relieving spinal cord compression, especially in multilevel degenerative cervical myelopathy (MDCM). [1][2][3][4][5][6][7][8][9] Currently, anterior cervical spinal fusion surgery including anterior cervical discectomy fusion (ACDF) and anterior cervical corpectomy fusion (ACCF) are routinely used in patients with MDCM. Although ACDF can alleviate the compression by removing the disc and osteophyte directly.…”