Lindsay Tetreault1,2, Jefferson R Wilson1,3, Mark R N Kotter1,4, Pierre Côté5, Aria Nouri1, Branko Kopjar6, Paul M Arnold7, Michael G Fehlings1. 1. Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada. 2. Graduate Entry Medicine, University College Cork, Cork, Ireland. 3. Department of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada. 4. Department of Clinical Neurosciences, Cambridge University, Cambridge, United Kingdom. 5. Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada. 6. Department of Health Services, School of Public Health, University of Washington, Seattle, Washington. 7. Department of Neurosurgery, University of Kansas, Kansas City, Kansas.
Abstract
BACKGROUND: Preoperative duration of symptoms may significantly impact outcomes in patients treated surgically for degenerative cervical myelopathy (DCM). OBJECTIVE: To (i) analyze whether duration of symptoms is associated with preoperative functional impairment, disability, and quality of life and (ii) determine the optimal timing for decompressive surgery. METHODS: Patients with DCM were prospectively enrolled in either the AOSpine North American or International study at 26 global sites (n = 757). Postoperative functional impairment was evaluated at 1-yr using the modified Japanese Orthopaedic Association (mJOA) score. Change scores between baseline and 1-yr were computed for the mJOA. Duration of symptoms was dichotomized into a "short" and "long" group at several cut-offs. Analysis of covariance was used to evaluate differences in change scores on the mJOA between duration of symptoms groups in 4-mo increments. RESULTS: Our cohort consisted of 424 men and 255 women, with a mean duration of symptoms of 26.1 ± 36.4 mo (0.25-252 mo). Duration of symptoms was not correlated with preoperative mJOA, Nurick, Neck Disability Index, or Short-Form (SF)-36 Physical and Mental Component Scores. Patients with a duration of symptoms shorter than 4 mo had significantly better functional outcomes on the mJOA than patients with a longer duration of symptoms (>4 mo). Thirty-two months was also a significant cut-off. CONCLUSION: Patients who are operated on within 4 mo of symptom presentation have better mJOA outcomes than those treated after 4 mo. It is recommended that patients with DCM are diagnosed in a timely fashion and managed appropriately.
BACKGROUND: Preoperative duration of symptoms may significantly impact outcomes in patients treated surgically for degenerative cervical myelopathy (DCM). OBJECTIVE: To (i) analyze whether duration of symptoms is associated with preoperative functional impairment, disability, and quality of life and (ii) determine the optimal timing for decompressive surgery. METHODS:Patients with DCM were prospectively enrolled in either the AOSpine North American or International study at 26 global sites (n = 757). Postoperative functional impairment was evaluated at 1-yr using the modified Japanese Orthopaedic Association (mJOA) score. Change scores between baseline and 1-yr were computed for the mJOA. Duration of symptoms was dichotomized into a "short" and "long" group at several cut-offs. Analysis of covariance was used to evaluate differences in change scores on the mJOA between duration of symptoms groups in 4-mo increments. RESULTS: Our cohort consisted of 424 men and 255 women, with a mean duration of symptoms of 26.1 ± 36.4 mo (0.25-252 mo). Duration of symptoms was not correlated with preoperative mJOA, Nurick, Neck Disability Index, or Short-Form (SF)-36 Physical and Mental Component Scores. Patients with a duration of symptoms shorter than 4 mo had significantly better functional outcomes on the mJOA than patients with a longer duration of symptoms (>4 mo). Thirty-two months was also a significant cut-off. CONCLUSION:Patients who are operated on within 4 mo of symptom presentation have better mJOA outcomes than those treated after 4 mo. It is recommended that patients with DCM are diagnosed in a timely fashion and managed appropriately.
Keywords:
Degenerative cervical myelopathy; Duration of symptoms; Modified Japanese Orthopedic Association score; Outcomes; Preoperative disease severity; Preoperative myelopathy severity; Surgery
Authors: Benjamin M Davies; Oliver Mowforth; Helen Wood; Zahabiya Karimi; Iwan Sadler; Lindsay Tetreault; Jamie Milligan; Jamie R F Wilson; Sukhvinder Kalsi-Ryan; Julio C Furlan; Yoshiharu Kawaguchi; Manabu Ito; Carl Moritz Zipser; Timothy F Boerger; Alexander R Vaccaro; Rory K J Murphy; Mike Hutton; Ricardo Rodrigues-Pinto; Paul A Koljonen; James S Harrop; Bizhan Aarabi; Vafa Rahimi-Movaghar; Shekar N Kurpad; James D Guest; Jefferson R Wilson; Brian K Kwon; Mark R N Kotter; Michael G Fehlings Journal: Global Spine J Date: 2022-02
Authors: Benjamin M Davies; Colin Munro; Danyal Z Khan; Siobhan M Fitzpatrick; Bryn Hilton; Oliver D Mowforth; Angus G K McNair; Iwan Sadler; Mark R N Kotter Journal: Global Spine J Date: 2020-11-18