Surgical Outcomes in Patients Operated for Cervical Myelopathy using Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire

Abstract

Study Design: This was a retrospective case series. Objective: The objective of the study was to assess the surgical outcomes of patients with cervical myelopathy, using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Summary of Background Data: Degenerative cervical myelopathy (DCM) is a leading cause of morbidity. Patients present with spasticity, gait imbalance, and loss of fine motor function. Most patients present early; however, few manage with disability for years and present late. Methods: Fifty-two consecutive patients underwent surgery for cervical myelopathy from 2008 to 2013; however, detailed follow-up was available in only 42 patients. Thirty-nine patients were ambulatory, while 3 were non-ambulatory at the outset. Nineteen patients underwent anterior surgery and 23 patients underwent posterior surgery. Frankel, Nurick grades, Neck Disability Index (NDI), and JOACMEQ scores were recorded at time of admission, 6, 12, 24, and 52 weeks, and then annually. Outcomes at final follow-up were included for statistical analysis. Results: Thirty-four (81%) patients improved, 4 (9.5%) patients remained static, and 4 (9.5%) patients worsened according to Nurick scale. Nurick grades improved from 3.52 to 1.64. Mean NDI scores improved from 42.28 to 20.28. Analyzing the JOACMEQ scores, cervical spine function improved in 15 (35.7%), upper extremity (UE) function improved in 33 (78.6%) patients, while lower extremity (LE) function improved in 32 (76.2%) patients. Bladder function improved in 17 (40.47%). Quality of life improved in 37 (88.1%) patients. LE improved more than UE, in the younger (<45 years) group, and in those with subaxial myelopathy. Pre-operative symptoms greater than 12 months had a negative impact on outcome. Pre-operative neurology, approach, and instrumentation did not impact outcomes. Four (9.5%) patients developed major neurological deficit, 4 (9.5%) patients had C5 deltoid palsy, while 1 patient had