Predictors for quality of life improvement after surgery for degenerative cervical myelopathy: a prospective multi-center study

Abstract

Background Degenerative cervical myelopathy (DCM) can significantly impair a patient’s quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. Methods This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. Results The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 − 0.493 × EQ-5D + 0.006 × LL − 0.008 × SS + 0.004 × TPA. Conclusions Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.

Patient Reported Data as Predictors of Surgical Outcome in Patients with Degenerative Cervical Myelopathy. Analysis of a National Multicenter Dataset

“…Previous studies have found that surgery for degenerative cervical myelopathy is associated with improvement, both in functional status and in quality of life 2,4,11,20. Our results are in line with those and expand the current evidence reported by previous investigators.…”

“…Multiple statistical comparisons have been made and the approach could be considered exploratory. However, the results are consistent with previous, smaller, studies 2,4,11,20,23,26,27…”

“…In the largest study to date (n=757), the authors concluded that a good outcome was more likely for patients who were younger, had milder preoperative myelopathy, did not smoke, had fewer and less severe comorbidities, did not present with impaired gait and had shorter symptom duration 7. Another study found that increased EuroQol-5 Dimension (EQ-5D) index one year postoperatively can be predicted by preoperative lumbar lordosis, sacral slope, and T1 pelvic angle 11…”

Health-Related Perceptions of Older Adults/Patients with Degenerative Lumbar Diseases (ODLs) are associated with their Quality of Life: a Mixed-Methods Study

“…This study was approved by the School of International and Public Affairs, Shanghai Jiao Tong University. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients prior to their participation in the study.…”

“…3 Thus, surgery-related factors are emphasized in major biomedical reports as the key points of improving their QOL. 4,5 But social risk determinants, such as perceived social support and level of education, 6,7 have been proved as predictors of elderly patient's QOL in some studies. Thus, this study was designed to examine the relationship of some social risk determinants and QOL of the older adults/patients with degenerative lumbar diseases (ODLs).…”