Evaluation of hand function in healthy individuals and patients undergoing uninstrumented central corpectomy for cervical spondylotic myelopathy using nine-hole peg test.

Abstract

To evaluate the hand function in healthy individuals and in patients with cervical spondylotic myelopathy (CSM) undergoing central corpectomy using the nine-hole peg test (NHPT). The NHPT was performed in healthy adults and in patients with CSM; overall, five trials were performed in the right and left hand separately. The preoperative and follow up NHPT score was compared to the normal and correlated with Nurick and modified Japanese Orthopedic Association (mJOA) scales. The NHPT score was significantly less in adult healthy female compared to adult healthy male subjects (difference, 0.71 s, P < 0.002). The distribution of the NHPT scores in normal adults followed the normal binomial distribution. The time taken to perform the NHPT with the right hand was significantly lower than the time taken to perform the NHPT with the left hand in both the sexes (P < 0.001). Thirty-six of the 47 patients with CSM (76.6%) had a prolonged preoperative NHPT score. There was a strong negative correlation between the preoperative NHPT score and the preoperative upper limb component of the modified-Japanese Orthopedic Association (UlmJOA) score. No significant change was detected in the NHPT score at one week postoperatively. On follow-up at six months or more (n = 21), the NHPT score normalized in five (35.7%) of the 14 patients in whom it was prolonged preoperatively. The NHPT score remained the same as the preoperative status in the other 16 patients, 7 of whom had a normal score preoperatively. The change in the NHPT score at follow-up did not correlate with the change in the UlmJOA score. Normative data among the Indian population suggest that female subjects have significantly lower scores than the male ones, and that there is a difference between the two sides that needs to be considered while reporting the NHPT scores in disease. The NHPT scores were prolonged preoperatively in CSM and showed a correlation with the UlmJOA score, and there was no significant change noted at one week follow-up. While the NHPT score is a good quantitative test to evaluate hand function in patients with CSM and could detect subtle hand dysfunction preoperatively, it has a limited role, when used alone, to detect changes in hand function postoperatively.