The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy

Abstract

Objective. To explore the most important predictors of post-operative efficacy in patients with degenerative cervical myelopathy (DCM). Methods. From January 2013 to January 2019, 284 patients with DCM were enrolled. They were categorized based on the different surgical methods used: single anterior cervical decompression and fusion (ACDF) (n = 80), double ACDF (n = 56), three ACDF (n = 13), anterior cervical corpectomy and fusion (ACCF) (n = 63), anterior cervical hybrid decompression and fusion (ACHDF) (n = 25), laminoplasty (n = 38) and laminectomy and fusion (n = 9). The follow-up time was 2 years. The patients were divided into two groups based on the mJOA recovery rate at the last follow-up: Group A (the excellent improvement group, mJOA recovery rate >50%, n = 213) and Group B (the poor improvement group, mJOA recovery rate ≤50%, n = 71). The evaluated data included age, gender, BMI, duration of symptoms (months), smoking, drinking, number of lesion segments, surgical methods, surgical time, blood loss, the Charlson Comorbidity Index (CCI), CCI classification, imaging parameters (CL, T1S, C2-7SVA, CL (F), T1S (F), C2-7SVA (F), CL (E), T1S (E), C2-7SVA (E), CL (ROM), T1S (ROM) and C2-7SVA (ROM)), maximum spinal cord compression (MSCC), maximum canal compromise (MCC), Transverse area (TA), Transverse area ratio (TAR), compression ratio (CR) and the Coefficient compression ratio (CCR). The visual analog score (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) and mJOA recovery rate were used to assess cervical spinal function and quality of life. Results. We found that there was no significant difference in the baseline data among the different surgical groups and that there were only significant differences in the number of lesion segments, C2–7SVA, T1S (F), T1S (ROM), TA, CR, surgical time and blood loss. Therefore, there was comparability of the post-operative recovery among the different surgical groups, and we found that there were significant differences in age, the duration of symptoms, CL and pre-mJOA between Group A and Group B. A binary logistic regression analysis showed that the duration of the symptoms was an independent risk factor for post-operative efficacy in patients with DCM. Meanwhile, when the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196). Conclusion. For patients with DCM (regardless of the number of lesion segments and the proposed surgical methods), the duration of symptoms was an independent risk factor for the post-operative efficacy. When the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196).

Normalizing Spinal Cord Compression Morphometric Measures: Application in Degenerative Cervical Myelopathy

“…The proposed MRI morphometrics significantly correlated with clinical scores (mJOA & CSA ratio: ρ=-0.29, p-value=0.004), better than the manually derived aMSCC (mJOA: ρ=0.09, p-value=0.4) and aSCOR (mJOA: ρ=-0.13, p-value=0.2). Previous studies reported no correlation between manual MRI morphometrics and mJOA 27–29 , or correlation for some morphometrics (compression ratio, MCC, and MSCC) with mJOA 12,30 . This could be caused by several factors including differences in cohort sizes and inclusion/exclusion criteria, variability in scanner field strengths (1.5T vs. 3.0T) and sequences used (axial vs. sagittal; T1w vs T2w), and intra– and inter-rater variability in manual measurements.…”

“…Only a few studies have used automatic or semi-automatic measures to compute spinal cord morphometrics 5,16,17,[31][32][33] . The majority of the studies measured the AP diameter on the midsagittal slice 1,12,29,[34][35][36] . However, the mid-sagittal slice may not correspond precisely to the middle of the spinal cord due to patient scoliosis and/or sequence positioning.…”

“…For example, spinal cord measures at the C2 vertebral level differ from those at the C4 vertebral level [9][10][11] . Maximum spinal cord compression (MSCC) is a popular index providing compression severity normalization by using the non-compressed levels above and below the compression site 12,13 . However, MSCC does not consider the varying spinal cord anatomy across spinal levels, which can lead to inaccuracies in the assessment of compression severity, as the measures may not reflect the true pathology extent.…”

Characterizing mJOA-defined post-surgical recovery patterns in patients with degenerative cervical myelopathy

“… 18 A recent study also concluded that duration of symptoms was an independent risk factor for post-operative efficacy, and that when the duration of symptoms was greater than 6.5 months, the prognosis was likely to be poor. 19 The reasons for this delay are multi-faceted. The diagnostic pathway usually begins with primary care physicians, and while delayed patient presentation likely contributes, delayed detection due to the variability of clinical presentation and the lack of knowledge of cervical cord compression signs and symptoms plays a significant role.…”

The impact of disease time, cervical alignment and range of motion on cervical vertebral HU value in surgery patients with cervical spondylosis

“…Multivariate analyses suggest that the C6-7 HU value was affected by disease time. Gou et al [24] suggest that the duration of symptoms was an independent risk factor for poor post-operative e cacy in patients with degenerative cervical myelopathy. Another study showed that intervertebral disc degeneration is related to osteopenia of adjacent vertebrae [25].…”