Is Preoperative Duration of Symptoms a Significant Predictor of Functional Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy?. Issue 5 (16th November 2018)

• Record Type: Journal Article
• Authors: Tetreault, Lindsay; Wilson, Jefferson R; Kotter, Mark R N; Côté, Pierre; Nouri, Aria; Kopjar, Branko; Arnold, Paul M; Fehlings, Michael G
• Is Part Of: Neurosurgery. Volume 85:Issue 5(2019)
• Page Start: 642
• Page End: 647
• Publication Date: 2018-11-16
• Subjects: Degenerative cervical myelopathy -- Modified Japanese Orthopedic Association score -- Surgery -- Outcomes -- Duration of symptoms -- Preoperative myelopathy severity -- Preoperative disease severity; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy474
• Languages: English
• ISSNs: 0148-396X

Abstract

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.