The Impact of Multidisciplinary Approaches to Social Functioning on Surgical Outcomes Following Surgery for Cervical Myelopathy

Abstract

Study Design. Prospective cohort study Objective. To identify the effects of multidisciplinary approaches (MAs) to improve social functioning (SF) on 1-year surgical outcomes in patients with cervical myelopathy Summary of Background Data. Despite significant improvement in cervical myelopathy, a patient’s quality of life (QOL) sometimes does not improve postoperatively. A previous study revealed that SF, rather than myelopathy severity, correlated with QOL improvement after decompression surgery for cervical myelopathy. Methods. This study compared two prospective cohorts in Japan. Patients who underwent cervical laminoplasty for cervical myelopathy from 2018 to 2020 were enrolled in the control cohort. Patients who underwent the same surgery with the same indications between 2020 and 2021 were enrolled in the MA cohort. Patients in the control cohort were treated with a standard care protocol and those in the MA cohort were treated with a multidisciplinary protocol that focused on SF improvement. The changes in the total JOA score and in the domains of the JOA scores (upper limb function, lower limb function, upper limb sensory, and lower limb sensory) from preoperatively to 1 year postoperatively were compared between the control and MA cohorts using a mixed-effect model. Results. The control and MA cohorts comprised 140 and 31 patients, respectively. The improvement in the Japanese Orthopaedic Association (JOA) score was significantly better in the MA cohort than in the control cohort (P=0.040). In analyses of each JOA score domain, the improvement of upper limb function was significantly better in the MA cohort than in the control cohort (P=0.033). Similarly, the MA cohort demonstrated significantly higher patient-reported outcome for upper extremity function than the control cohort (P<0.001). Additionally, the self-care domain of QOL score at 1 year postoperatively was significantly higher in the MA cohort than in the control cohort (P=0.047). Conclusion. MAs to improve/rebuild a patient’s SF were effective in improving cervical myelopathy and self-care domain of QOL. This study is the first to demonstrate the effectiveness of a postoperative MAs in patients with cervical myelopathy. Level of Evidence. III

Residual Paresthesia After Surgery for Degenerative Cervical Myelopathy

“…SPINE20, which is a well-recognized advocacy group for spinal disability, published a recommendation to adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability 30 . Further, some efforts with conduct a multidisciplinary approach with patients with DCM have been reported 31,32 . However, there have been no reported attempts to reduce residual symptoms of paresthesia through a multidisciplinary approach.…”

“…30 Further, some efforts with conduct a multidisciplinary approach with patients with DCM have been reported. 31,32 However, there have been no reported attempts to reduce residual symptoms of paresthesia through a multidisciplinary approach. Finally, detailed and precise preoperative explanations regarding the symptoms of paresthesia might positively influence treatment satisfaction.…”