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

Abstract

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.

Posterior Decompression and Fixation for Thoracic Spine Ossification: A 10-Year Follow-Up Study

“…This design inherently introduces certain complexities, including the variability in pre-surgical JOA scores among patients. Although some studies have posited that shorter durations from symptom onset to surgery can result in better JOA improvements, our findings did not explicitly corroborate this [34,35]. Notably, in real-world clinical settings, a subset of patients often defer seeking medical attention until a significant duration has passed from symptom onset, usually when their myelopathy has considerably worsened.…”

Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy

“…Importantly, the mJOA does not distinguish between unilateral and bilateral sensory loss, which could raise the risk of misclassifying radiculopathy as myelopathy, in which unilateral sensory loss is a feature. In a recent study, sensory disturbance was the presenting symptom in 19% of 411 people with DCM but it was not reported if this was bilateral or unilateral ( Özkan et al, 2022 ).…”

“…People with moderate and severe DCM will be recommended to have decompressive surgery, which has been shown to improve or stabilise neurological function, disability and quality of life ( Fehlings et al, 2017 ). Surgery is generally considered to be time-sensitive, as shorter duration of symptoms may be associated with better outcomes following surgery ( Tetreault et al, 2019 ), though the extent of this varies between studies and may depend on how outcomes are measured and analysed ( Evaniew et al, 2020 ) and which symptoms present first ( Özkan et al, 2022 ). Irrespective of a clearly-defined “window” for optimal recovery with surgery, a timely diagnosis is desirable from the point of view of understanding symptoms, monitoring change over time, and informing future management.…”

The Role of Magnetic Transcranial Stimulation in the Diagnosis and Post-Surgical Follow-Up of Cervical Spondylotic Myelopathy

“…Various studies have shown that the most significant improvement is achieved after surgery in cases with mild-to-moderate functional involvement evaluated with the different functionality scales, compared to those with severe involvement where part of the damage could be irreversible [ 15 ]. Good postsurgical outcome is related to younger age, absence of radiographic myelopathy signs, less duration of symptoms before surgery and the presence of sensory instead of motor or gait disturbance as first symptoms [ 23 , 24 , 25 ]. The aim of our study was to correlate the clinical outcome measured by scales with the neurophysiological sensory and motor tests evolution.…”