Long-term functional outcome of surgical treatment for degenerative cervical myelopathy

Abstract

OBJECTIVE Degenerative cervical myelopathy (DCM) is a major global cause of spinal cord dysfunction. Surgical treatment is considered a safe and effective way to improve functional outcome, although information about long-term functional outcome remains scarce despite increasing longevity. The objective of this study was to describe functional outcome 10 years after surgery for DCM. METHODS A prospective observational cohort study was undertaken in a university-affiliated neurosurgery department. All patients who underwent surgery for DCM between 2008 and 2010 as part of the multicenter Cervical Spondylotic Myelopathy International trial were included. Participants were approached for additional virtual assessment 10 years after surgery. Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA; scores 0–18) score at baseline and 1, 2, and 10 years after surgery. The minimal clinically important difference was defined as 1-, 2-, or 3-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilization or improvement after 2 years was maintained at 10 years. Self-evaluated effect of surgery was assessed using a 4-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models. RESULTS Of the 42 originally included patients, 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years). The mean mJOA score increased significantly from 13.1 (SD 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p = 0.01). A minimal clinically important difference was achieved in 54.1%, and stabilization of functional status was maintained in 75.0% in the long term. Patients who worsened were older (median 63 vs 52 years, p < 0.01) and had more comorbidities (70.0% vs 25.9%, p < 0.01). A beneficial effect of surgery was self-reported by 78.3% of patients. CONCLUSIONS Surgical treatment for DCM results in satisfactory improvement of functional outcome that is maintained at 10-year follow-up.

Long-Term Results After Surgery for Degenerative Cervical Myelopathy

“…This study demonstrated satisfactory results with a significant increase in mean modified Japanese Orthopedic Association (mJOA) score from baseline to a 2-year follow-up, and the results were unchanged at a 10-year follow-up. 9 A recent retrospective study with 195 patients with a mean follow-up of 6.3 years demonstrated neurological improvement in 89% at 5 years and 76% at 10 years. No PROMs were reported in the long-term follow-up in this study.…”

“…This study demonstrated satisfactory results with a significant increase in mean modified Japanese Orthopedic Association (mJOA) score from baseline to a 2-year follow-up, and the results were unchanged at a 10-year follow-up. 9…”

“…20 Stabilization of myelopathy was considered satisfactory and durable if the outcome measure was unchanged or improved from 1 year to longterm follow-up. 9…”

“…7,8 Although the evidence for improvement after surgical treatment for DCM is increasing, especially in the short term, evidence for long-term outcomes is limited. 9,10 Data from the Norwegian registry for spine surgery (NORspine) have shown significant and clinically meaningful improvement after surgery across a wide range of patient-reported outcome measures (PROMs) at a 1-year follow-up. 11 The aim of this study was to investigate whether the outcome after surgery for DCM persists at long-term follow-up.…”

“…Although the evidence for improvement after surgical treatment for DCM is increasing, especially in the short term, evidence for long-term outcomes is limited. 9,10…”