Multidimensional assessment of cervical spondylotic myelopathy patients. Usefulness of a comprehensive score system

Abstract

Objective Cervical spondylotic myelopathy (CSM) is caused by cervical spine degeneration and surgery may be beneficial, but selection for surgery might be challenging. We performed a multimodal analysis to assess predicting factors that may be useful to help surgeons in this choice. Patients and methods We retrospectively evaluated clinical, motor evoked potentials (MEP), and MRI data of patients who undergone surgery for CSM. Seventy-six consecutive patients (46 males) were enrolled. The median age was 65.5 [IQR: 57–71] years, and the duration of symptoms was 11 [8–13] months. A multivariate analysis in order to assess predictors of outcome and ROC curve analysis were performed. Results Thirty patients (M:18, 39.5%) gained 6 or more points on mJOA and they were collected in good recovery group, whereas 46 patients (60.5%, M:28) showed a fair recovery. We developed a comprehensive score system (CSS) taking into account clinical, neurophysiological, and neuroradiological data. ROC curve analysis was performed to determine the discriminative power of four models derived from the multivariate logistic regression analysis for predictors of good outcome considering only clinical variables, MRI variables, and MEP variables or considering the comprehensive model, demonstrating a good accuracy of CSS model to predict outcome. Conclusion This study demonstrates that CSS model taking into consideration functional assessment by mJOA score, neurologic evaluation, cervical MRI, and MEP may be a feasible method to predict outcome in patients candidate to surgery, supporting surgeon’s decisions both for those patients candidate to surgery and for patients in whom a “wait and see” approach could be proposed.

[Retracted] Clinical Application of Evoked Potentials in the Operation of Cervical Spondylotic Myelopathy with Different Imaging

“…Its pathological basis is the degeneration of facet joints and intervertebral discs, secondary to the formation of osteophytes in the backyard of adjacent vertebral joints that in turn leads to pairs of spinal cords or innervated spinal blood vessel compression, and patients may have various degrees of spinal cord dysfunction. [ 8 – 10 ] The current clinical practice is mainly surgery in order to improve blood supply to the spinal cord and reduce spinal cord lesions whose purpose is to relieve compression. In this study, both the case group and the control group have undergone spinal cord decompression, and the postoperative recovery satisfaction is excellent, indicating the clinical treatment effect of spinal cord decompression with the surgery is affirmative and stable and has a satisfactory curative effect.…”

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis

“…Signs with poor sensitivity include motor deficit of individual muscle groups, clonus (.31, 95% CI 0.28 to .34), ataxia (.33, 95% CI 0.29 to .38), atrophy of intrinsic hand muscles (.38, 95% CI 0.35 to .41), Babinski (.42, 95% .41 to .44), and Romberg (.42, 95% .34 to .49). 10,18,20-22,24,28-90 The supplemental material provides a complete summary of the average sensitivities of various clinical s...…”

“…24 , 25 , 27 - 29 Sensitivity was calculated from 61 studies that reported on the frequency of clinical signs in a cohort of patients with DCM. 10 , 30 - 89 …”

Logistic Model and Gradient Boosting Machine Model for Physical Therapy of Lumbar Disc Herniation

“…The logistic curve model was used for the mathematical expression on the treatment process of cervical radicular pain. The prediction of the effect of physical therapy on cervical radicular pain was achieved by further mathematical feature analysis and predictive ability analysis [ 21 – 23 ]. During physical therapy, patients with cervical spondylosis show a closer course of remission than patients with lumbar disc herniation.…”