Is Preoperative Duration of Symptoms a Significant Predictor of Functional Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy?

Tetreault, Lindsay; Wilson, Jefferson R.; Kotter, Mark R N; Côté, Pierre; Nouri, Aria; Kopjar, Branko; Arnold, Paul M.; Fehlings, Michael G.

doi:10.1093/neuros/nyy474

Cited by 30 publications

(38 citation statements)

References 32 publications

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“…The Table 3 shows the analysis of changes in the outcome parameter mJOA pre and postoperatively. The patients were divided according to preoperatively mJOA score in three groups, mild (mJOA˃15), moderate (mJOA [12][13][14] and severe myelopathy (mJOA ˂12). The extent of improvement was statistically significant in all three category of patients according to mJOA score (p˂0,001).…”

Section: Resultsmentioning

confidence: 99%

“…It seems well established that the surgical treatment of CSM is better than no treatment, although even this assumption continuous to be questioned. The results of some study indicate that the outcome of surgically treated CSM has not been better in comparison to the natural history or nonoperative therapy and notes that there are no clear guidelines for selection of patients who will benefit from surgery, while other study favored surgical management (6,12,13). The confounding variables are the often slow, variable natural history and the absence of randomized, controlled studies to allow evidence-based treatment choices (6,13).…”

Section: Discussionmentioning

confidence: 99%

“…Outcome evaluations included three outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick score and the Neck Disability Index (NDI), were obtained preoperatively and 12 months postoperatively, and functional recovery ratio was evaluated by using the formula of Hirabayashi (7,8,9,10). According to preoperative mJOA scores, the patients were classified as having mild (mJOA˃15), moderate (mJOA [12][13][14] and severe myelopathy (mJOA ˂12).…”

Section: Outcome Assesmentsmentioning

confidence: 99%

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Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

2021

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Background/Aim. Treatment options for cervical spondyltic myelopathy (CSM) are the topic for discussion due to lack of controlled randomized prospective study. Also, the natural history of CSM is unpredictable and efficacy of surgical decompression is still controversial. The aim of this prospective study was to describe results of surgical treatment of patients with CSM in a single institution. Methods. Fifty nine patients with symptomatic CSM were enrolled in this single center prospective study, at the end of follow-up period of 12 months, 50 patients were analyzed. All patients were operated, surgical decompression was performed by anterior or posterior surgical approach. Outcome evaluations were obtained preoperatively and 12 months postoperatively by using outcome measures: the modified Japanese Orthopedic Association (mJOA) scale, the Nurick score and the Neck Disability Index (NDI). Functional recovery ratio was calculated postoperatively by using the formula of Hirabayashi. Results. According to our results, significant improvements were detected in all outcomes variables (mJOA score, Nurick score and NDI). Also, statistically significant improvement was observed in all three category of patients according to preoperative mJOA score (mild, moderate, severe). Twenty three (46%) patients had satisfied functional recovery, while twenty seven (54%) had unsatisfied functional recovery rate. Conclusion. Surgical treatment of CSM is a very effective and resulted in a significant improvement in all outcomes measures for 1 year follow-up period. We could recommend new studies to evaluating the course of disease, to define the optimal surgical strategy, and better determination of surgical outcome predictors.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Outcome Assesmentsmentioning

confidence: 99%

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Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

2021

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“…The present study also revealed that hyperechogenicity in the dorsal part was more severe than that of the ventral spinal cord, while the RR of the JOA-S score was not as good as that of the JOA-M score. Previous studies that focused on the prevalence of pre- or post-operative symptoms of DCM also reported that sensory impairment was more common and more persistent [ 25 26 ]. For DCM, compression of the spinal cord is always from the ventral aspect, but the impairment based on IOUSI occurred more often and was more severe in the dorsal part.…”

Section: Discussionmentioning

confidence: 99%

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

Chen

Wei

et al. 2021

Korean J Radiol

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Objective To analyze the correlations between intraoperative ultrasound and MRI metrics of the spinal cord in degenerative cervical myelopathy and identify novel potential predictive ultrasonic indicators of neurological recovery for degenerative cervical myelopathy. Materials and Methods Twenty-two patients who underwent French-door laminoplasty for multilevel degenerative cervical myelopathy were followed up for 12 months. The Japanese Orthopedic Association (JOA) scores were assessed preoperatively and 12 months postoperatively. Maximum spinal cord compression and compression rates were measured and calculated using both intraoperative ultrasound imaging and preoperative T2-weight (T2W) MRI. Signal change rates of the spinal cord on preoperative T2W MRI and gray value ratios of dorsal and ventral spinal cord hyperechogenicity on intraoperative ultrasound imaging were measured and calculated. Correlations between intraoperative ultrasound metrics, MRI metrics, and the recovery rate JOA scores were analyzed using Spearman correlation analysis. Results The postoperative JOA scores improved significantly, with a mean recovery rate of 65.0 ± 20.3% ( p < 0.001). No significant correlations were found between the operative ultrasound metrics and MRI metrics. The gray value ratios of the spinal cord hyperechogenicity was negatively correlated with the recovery rate of JOA scores (ρ = −0.638, p = 0.001), while the ventral and dorsal gray value ratios of spinal cord hyperechogenicity were negatively correlated with the recovery rate of JOA-motor scores (ρ = −0.582, p = 0.004) and JOA-sensory scores (ρ = −0.452, p = 0.035), respectively. The dorsal gray value ratio was significantly higher than the ventral gray value ratio ( p < 0.001), while the recovery rate of JOA-motor scores was better than that of JOA-sensory scores at 12 months post-surgery ( p = 0.028). Conclusion For degenerative cervical myelopathy, the correlations between intraoperative ultrasound and preoperative T2W MRI metrics were not significant. Gray value ratios of the spinal cord hyperechogenicity and dorsal and ventral spinal cord hyperechogenicity were significantly correlated with neurological recovery at 12 months postoperatively.

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“…Symptom duration was described as a negative outcome predictor in several studies [18,23,24]. Holly et al highlight the importance of symptom duration and age for the postoperative outcome of DCM patients [17].…”

Section: Discussionmentioning

confidence: 99%

First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

et al. 2021

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Purpose Degenerative cervical myelopathy (DCM) is the most common non-traumatic cause of spinal cord dysfunction. Prediction of the neurological outcome after surgery is important. The aim of this study was to analyze the relationship between first symptoms of DCM and the neurological outcome after surgery. Methods A retrospective analysis over a period of 10 years was performed. First symptoms such as cervicobrachial neuralgia, sensory and motor deficits and gait disturbances were evaluated regarding the postoperative neurological outcome. The modified Japanese Orthopedic Association Score (mJOA Score) was used to evaluate neurological outcome. Results In total, 411 patients (263 males, 64%) with a median age of 62.6 ± 12.1 years were included. Cervicobrachial neuralgia was described in 40.2%, gait disturbance in 31.6%, sensory deficits in 19% and motor deficits in 9.2% as first symptom. Patients with cervicobrachial neuralgia were significantly younger (median age of 58 years, p = 0.0005) than patients with gait disturbances (median age of 68 years, p = 0.0005). Patients with gait disturbances and motor deficits as first symptom showed significantly lower mJOA Scores than other patients (p = 0.0005). Additionally, motor deficits and gait disturbance were negative predictors for postoperative outcome according to the mJOA Score. Conclusion Motor deficits and gait disturbances as the first symptom of DCM are negative predictors for postoperative neurological outcome. Nevertheless, patients with motor deficits and gait disturbance significantly profit from the surgical treatment despite poor preoperative mJOA Score.

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Is Preoperative Duration of Symptoms a Significant Predictor of Functional Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy?

Cited by 30 publications

References 32 publications

Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

Efficacy of surgical treatment in patients with cervical spondylotic myelopathy

Intensity of Intraoperative Spinal Cord Hyperechogenicity as a Novel Potential Predictive Indicator of Neurological Recovery for Degenerative Cervical Myelopathy

First neurological symptoms in degenerative cervical myelopathy: does it predict the outcome?

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