Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P112. Treatment of mild cervical myelopathy: which factors predict the decision for surgical intervention?

Abstract

BACKGROUND CONTEXT Surgical treatment of cervical myelopathy is associated with improved outcomes in patients across all stages of disease severity. However, a trial of supervised rehabilitation is recommended as an alternative to surgical treatment for patients with mild cervical myelopathy (Modified Japanese Orthopaedic Association (MJOA) scale score ≥15). PURPOSE The purpose of this study was to evaluate which factors predicted selection for surgical intervention in patients with mild cervical myelopathy. METHODS Patients with cervical myelopathy from seven Canadian centers were prospectively enrolled in the Canadian Spine Outcomes Research Network (CSORN) database. Demographic, clinical, radiographic, and health related quality of life (HRQOL) data was collected on all patients for baseline data. Multivariate logistic regression modeling was used to identify predictors of surgical intervention. RESULTS Three hundred sixty patients were enrolled, of which 96 patients were categorized as mild myelopathy. Eighty-three (86.4%) were treated surgically and 13 (13.6%) were treated conservatively. Sixty of those with mild myelopathy (62.5%) were male and the mean age was 55.7 (SD 12.6) years old. There were no differences between surgical and nonsurgical patients with respect to BMI, duration of symptoms, medical comorbidities and age. MJOA scores were higher in the nonoperative group (17.0 SD 0.89vs. 15.0 SD 0.93, p=.002). Patients who underwent surgery had higher baseline neck pain (5.18vs. 4.53) and higher disability (NDI) (35.03vs. 33.87) scores which did not reach statistical significance. There was no difference between groups for any radiographic parameters including spinal cord compression, spine alignment, and cord signal change. Multivariate analysis revealed that the selection of patients for surgical intervention was predicted by symptoms of less than one year duration, higher neck pain scores, lower quality of life scores (EQ5D), and higher disability (NDI) scores. CONCLUSIONS Patients who were treated surgically for mild cervical myelopathy did not differ from those treated nonoperatively with respect to demographic or radiographic parameters. After adjusted analysis patients were more likely to have surgical intervention if duration of symptoms was shorter and they had worse pain and quality of life scores.