Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations

Abstract

This study is conducted to review the literature systematically to determine most reliable outcome measures, important clinical and radiological variables affecting the prognosis in cervical spondylotic myelopathy patients. A literature search was performed for articles published during the last 10 years. As functional outcome measures we recommend to use modified Japanese Orthopaedic Association scale, Nurick's grade, and Myelopathy Disability Index. Three clinical variables that affect the outcomes are age, duration of symptoms, and severity of the myelopathy. Examination findings require more detailed study to validate their effect on the outcomes. The predictive variables affecting the outcomes are hand atrophy, leg spasticity, clonus, and Babinski's sign. Among the radiological variables, the curvature of the cervical spine is the most important predictor of prognosis. Patients with instability are expected to have a poor surgical outcome. Spinal cord compression ratio is a critical factor for prognosis. High signal intensity on T2-weighted magnetic resonance images is a negative predictor for prognosis. The most important predictors of outcome are preoperative severity and duration of symptoms. T2 hyperintensity and cord compression ratio can also predict outcomes. New radiological tests may give promising results in the future.

Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach

“…found that the age is a significant clinical variable affecting the outcome, but did not identify a cut-off value (28). Several studies reported that age greater than 65 years should be considered as a negative predictor in DCM (29,30).…”

“…Conceptually, it seems legitimate to think that the longer duration of symptoms, the more consequential and potentially irreversible the spinal cord damage is, thus reducing the possibility of improvement even after surgery. The literature also goes in this direction with recent reviews identifying preoperative myelopathy severity assessment scores (JOA/mJOA and Nurick) and the duration of symptoms as significant predictive factors of surgical outcome (27,28,31,34). Handa et al…”

“…Recent studies suggested that patients with an FAvalue >0.55 represent the best responders to surgery at 1-year (27,53). Additional advanced MRI techniques such as magnetization transfer, T2* and spectroscopy as well as others, are also promising techniques that remain the subject of ongoing investigations (28).…”

Internet of Things, Digital Biomarker, and Artificial Intelligence in Spine: Current and Future Perspectives

“…43 Gait disturbance is an important sign of compressive myelopathy. 44,45 If gait is monitored in real time by sensors mounted on shoes or wearable devices, it is possible to promptly diagnose the progression of myelopathy in patients with cervical stenosis or ossification of posterior longitudinal ligament. Hand dexterity can be a digital biomarker in patients with cervical myelopathy.…”

Degenerative Cervical Myelopathy: Natural History, Clinical Presentation, Current Diagnosis and Treatment Review

“…Moderate and severe cases should be surgically treated [16,18] . However, long-term compression, age, spinal cord atrophy, low signal on T1-weighted images, and high signal on T2-weighted on MRI are signs of poor outcome [19][20][21] .…”