Surgical treatment for degenerative cervical myelopathy is associated with long-term improvements in functional outcome

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Surgical treatment for degenerative cervical myelopathy (DCM) leads to a satisfactory improvement of functional outcome which is maintained out to 10 years, a recent study has found. Published in the Journal of Neurosurgery: Spine by Mark Dijkman (Radboud University Medical Centre, Nijmegen, The Netherlands) et al, the study sought to describe functional outcome a decade after surgery for DCM.

This was a prospective observational cohort study which included all patients who underwent surgery for DCM between 2008 and 2010 as part of the multicentre Cervical Spondylotic Myelopathy International trial. Participants were approached for additional virtual assessment 10 years after surgery.

Functional outcome was assessed according to the modified Japanese Orthopaedic Association (mJOA) score at baseline and one, two, and 10 years’ post-surgery. The minimal clinically important difference was defined as one-, two-, or three-point improvement for mild, moderate, and severe myelopathy, respectively. Outcome was considered durable when stabilisation or improvement after two years was maintained at 10 years.

Self-evaluated effect of surgery was assessed using a four-point Likert-like scale. Demographic, clinical, and surgical data were compared between groups that worsened and improved or remained stable using descriptive statistics. Functional outcome was compared between various time points during follow-up with linear mixed models.

Out of the 42 patients who were originally included in the study, a total of 37 participated at follow-up (11.9% loss to follow-up, 100% response rate). The mean patient age was 56.1 years, and 42.9% of patients were female. Surgical approaches were anterior (76.2%), posterior (21.4%), or posterior with fusion (2.4%). The mean follow-up was 10.8 years (range 10–12 years).

The mean mJOA score increased significantly from 13.1 (standard deviation [SD] 2.3) at baseline to 14.2 (SD 3.3) at 10 years (p=0.01). A minimal clinically important difference was achieved in 54.1%, and stabilisation of functional status was maintained in 75% in the long term. Patients who worsened were older (median age 63 vs. 52 years; p<0.01) and had more comorbidities (70% vs 25.9%; p<0.01). A beneficial effect of surgery was self-reported by 78.3% of patients.


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