Surgery for degenerative cervical myelopathy (DCM) is associated with significant and clinically-relevant improvements across a wide range of patient-reported outcomes at one year, a new study has found.
The findings of this Norwegian nationwide registry-based observational study—which were published by Sasha Gulati (St Olavs University Hospital, Trondheim, Norway) et al in Neurosurgery—indicated favourable outcomes at one year for both mild and moderate-to-severe DCM.
The study authors wrote that surgical treatment “cannot only arrest further progression of myelopathy but also improve functional status, neurological outcomes, and quality of life”.
Data were obtained from the Norwegian Registry for Spine Surgery (NORspine) and a total of 905 patients were included in the study.
The primary outcome was change in the neck disability index (NDI) one year post-surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale.
There were significant improvements in all patient-reported outcome measures (PROMS) including NDI (mean −10; 95% confidence interval [CI], −11.5 to −8.4, p<0.001), EMS (mean 1.0, 95%; CI 0.8–1.1, p<0.001), EQ-5D index score (mean 0.16; 95% CI, 0.13–0.19, p<0.001), EQ-5D visual analogue scale (mean 13.8; 95% CI 11.7–15.9, p<0.001), headache NRS (mean −1.1; 95% CI −1.4 to −0.8, p<0.001), neck pain NRS (mean −1.8; 95% CI −2 to −1.5, p <0.001), and arm pain NRS (mean −1.7; 95% CI −1.9 to −1.4, p<0.001).
According to GPE scale assessments, 44.6% of patients experienced “complete recovery” or felt “much better” at one year. In addition, 27.3% of patients reported feeling “slightly better” at one, postoperatively. There were significant improvements in all PROMs for both mild and moderate-to-severe DCM. A total of 251 patients (27.7%) experienced adverse effects within three months.
Gulati told Spinal News International: “Our study supports the role of surgery in the management of DCM. Approximately three out of four patients who underwent surgery reported at least some improvement at one-year follow-up. Importantly, clinically meaningful improvements were observed for patients with all variants of disease severity. For those interested in surgical strategies, it is worth noticing that nearly 40% of our patients underwent posterior non-instrumented surgery.”