Preoperative Predictors of Patient Satisfaction with Outcome after Cervical Laminoplasty

Abstract

Study design Prospective cohort study. Objective The purpose of the present study was to identify the predictors of patient satisfaction with outcome after cervical laminoplasty for compressive cervical myelopathy. Methods A cohort of 143 patients with compressive myelopathy who underwent cervical double-door laminoplasty between 2008 and 2011 was studied prospectively. The principal outcome was patient satisfaction with outcome at 1 year after surgery. Patient satisfaction was graded on an ordinal scale from 1 to 7. Subjective health-related quality of life (QOL) and objective disease-specific outcome was measured by Short Form-36 (SF-36) and the Japanese Orthopaedic Association (JOA) score, respectively, before surgery and at 1-year follow-up. We evaluated the association between patient satisfaction at 1-year follow-up and various baseline parameters, including patient demographics, duration of symptoms, comorbidities, imaging findings, JOA score, and SF-36 scores. Results A total of 116 patients completed subjective and objective follow-up for a minimum of 1 year. Of 116 patients, 95 patients (81.9%) were satisfied with the outcome (“satisfied a little” or more). The unsatisfied group (“neutral” or less) showed significantly lower baseline SF-36 scores in bodily pain (BP), general health perceptions (GH), and vitality (VT) domains compared with the satisfied group. At the 1-year follow-up, SF-36 scores showed significant differences between the groups in all eight domains, whereas the JOA score showed no significant difference. Conclusions Lower baseline QOL measured by SF-36 scores, specifically in BP, GH, and VT domains, are associated with lower satisfaction with outcome after cervical laminoplasty.

A Clinical Practice Guideline for the Management of Patients With Degenerative Cervical Myelopathy: Recommendations for Patients With Mild, Moderate, and Severe Disease and Nonmyelopathic Patients With Evidence of Cord Compression

“…The majority of conclusions for this review were derived from a single randomized controlled trial by Kadanka et al 25 This randomized controlled trial reported that, in patients with “milder” myelopathy (mJOA ≥ 12), (1) there was no difference in mJOA scores at 1-, 2-, 3- and 10-year follow-up between patients that received operative versus nonoperative care; (2) surgery resulted in a slower 10-m walk test than nonoperative treatment; and (3) there was no difference between treatment groups in the proportion of patients with worsened or improved clinician-based or patient reported daily activity scores (low level evidence). 25 , 26 However, no improvements in the mJOA were observed in the operative cohort of this trial, which differs from the results reported in other series of myelopathic patients undergoing surgical decompression 12 , 19 , 27 – 34 ; this may partially explain their finding of no difference between treatment groups. Finally, based on low level evidence, rates of hospitalization for subsequent spinal cord injury were significantly higher in patients undergoing initial conservative treatment compared to those managed operatively (HR (ref = operative treatment) = 1.57; 95% CI = 1.11-2.22, P = .011).…”

Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

“…17 –20,22 –24,28,30 –34,37,39,40,44 –48 The risk of bias was low or moderately low in 14 studies 17,18,22,23,28,30,31,33,34,39,44 –46,48 and moderately high in 7 because of undefined or low follow-up rates. 19,20,24,32,37,40,47 A strong effect for improvement in function was observed at each time point ( P < .001): the pooled SMD across 10 studies was 1.92 (95% confidence interval [CI] = 1.41 to 2.43) at 12-months follow-up (Figure 2a) 20,22 –24,28,30,32,34,45,48 ; 1.40 (95% CI = 1.12 to 1.67) across 12 studies at 13- to 36-months follow-up (Figure 2b) 17,23,30 –34,37,…”

“…Thirty-two studies ultimately met the inclusion criteria and are summarized in this review. 17 – 48 Study characteristics are provided in Table 2 ; sample sizes ranged from 52 to 479 patients, mean ages ranged from 46 to 65 years and males comprised between 34% and 94% of the study populations. Disease pathoanatomy was also variable, with 9 studies including patients with OPLL (range = 6.6% to 33.6% of patients); of the remaining studies, 12 specifically excluded OPLL patients and 6 did not specify whether or not OPLL patients were included.…”

“…Disease pathoanatomy was also variable, with 9 studies including patients with OPLL (range = 6.6% to 33.6% of patients); of the remaining studies, 12 specifically excluded OPLL patients and 6 did not specify whether or not OPLL patients were included. Surgical approaches expectedly varied across studies: 7 included anterior decompression and fusion techniques only 18 , 20 , 30 , 35 , 37 , 42 , 43 , 45 ; 12 included posterior decompression techniques that were either motion-preserving (laminectomy or laminoplasty) or used fusion 24 , 25 , 27 , 28 , 31 , 33 , 34 , 36 , 39 , 40 , 44 , 46 , 47 ; and 8 studies incorporated both techniques. 17 , 19 , 21 – 23 , 26 , 29 , 32 , 38 , 41 , 48 …”

Prevalence of complications after surgery in treatment for cervical compressive myelopathy

“…Thirty-six studies [20,22–24,27,28,34,35,38,39,42,45,47,48,56,57,60–62,65,66,69–71,73,74,79,81,82,84–86,88,90,91,116] containing 129 patients with CSF of 5007 patients after cervical surgery were included. Figure 15 shows that the incidence was 1.9% (95% CI 1.3%–2.4%), with substantial heterogeneity of incidence observed.…”