Functional and Quality of Life Outcomes of Surgery for Degenerative Cervical Myelopathy: A Quality Improvement Study
-
Babak Mirzashahi
,
Pejman Mansouri
,
Arvin Najafi
,
Saeed Besharati
,
Mohammad Taha Kouchakinejad
,
Alireza Mohseni
,
Pouria Rezaeian
Abstract
Background: This study aimed to determine the outcome of surgical treatments in patients with degenerative cervical myelopathy (DCM). During one-year follow-up period, we evaluated patient-reported functional and quality of life (QOL) measures.
Methods: In a retrospective single-center study, we collected data of patients with DCM who underwent cervical fusion surgeries in Imam Khomeini Hospital, Tehran, Iran, from 2011 to 2015. Patients underwent single or multi-level anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), or posterior laminectomy and fusion. We utilized patient-reported assessments including Short Form 36 (SF-36), Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Nurick grade. Follow-up was performed at 6 weeks, 3 months, 6 months, and 12 months post-operatively to assess the outcome of the surgery.
Results: Ninety patients (56 men, 34 women) with a mean age of 54.1 (27-87) years were included. Comparison of pre- and post-operative scores showed significant improvement in SF-36 parameters, VAS, NDI, and Nurick grade (P < 0.001). Also, women’s VAS scores improved more than men's VAS scores during the follow-up period (P < 0.050). Age and type of surgery did not significantly affect the SF-36 parameters, VAS, NDI, and Nurick grade (P > 0.05).
Conclusions: Cervical surgeries in patients with different severity of DCM can improve different aspects of QOL during one-year after surgery.
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2. Yamazaki S, Kokubun S, Ishii Y, Tanaka Y. Courses of cervical disc herniation causing myelopathy or radiculopathy: an analysis based on computed tomographic discograms. Spine. 2003;28(11):1171-5.
3. Bernhardt M, Hynes R, Blume H, White A. Cervical spondylotic myelopathy. J Bone Joint Surg Am. 1993;75(1):119-28.
4. Hillard VH, Apfelbaum RI. Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy. The Spine Journal. 2006;6(6):S242-S51.
5. Konya D, Ozgen S, Gercek A, Pamir MN. Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy. Journal of Clinical Neuroscience. 2009;16(3):404-9.
6. Manzano GR, Casella G, Wang MY, Vanni S, Levi AD. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery. 2012;70(2):264-77.
7. Anderson PA, Matz PG, Groff MW, Heary RF, Holly LT, Kaiser MG, et al. Laminectomy and fusion for the treatment of cervical degenerative myelopathy. Journal of Neurosurgery: Spine. 2009;11(2):150-6.
8. Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al. Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy. The Journal of Bone & Joint Surgery. 2013;95(18):1651-8.
9. Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases: Clinical article. Journal of Neurosurgery: Spine. 2011;14(3):348-55.
10. Ware-JE J, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30: 473–83.
11. Aitken RC. Measurement of feelings using visual analogue scales. Proceedings of the royal society of medicine. 1969 Oct;62(10):989.
12. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. Journal of manipulative and physiological therapeutics. 1991 Sep;14(7):409-15.
13. Nurjck S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972 Jan 1;95(1):87-100.
14. Brain WR, Northfield D, Wilkinson M. The neurological manifestations of cervical spondylosis. Brain. 1952;75(2):187-225.
15. Epstein N. Efficacy and outcomes of dynamic-plated single-level anterior diskectomy/fusion with additional analysis of comparative costs. Surgical neurology international. 2011;2:9.16. Rhee JM, editor Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Seminars in Spine Surgery; 2007: Elsevier.
17. Yang H-L, Chen G-D, Zhang H-T, Wang L, Luo Z-P. Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease. Clinical Spine Surgery. 2013;26(1):E13-E8.
18. Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP. Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery: Clinical article. Journal of Neurosurgery: Spine. 2013;18(6):537-44.
19. Singh A, Gnanalingham K, Casey A, Crockard A. Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine. 2006;31(6):639-43.
20. Highsmith JM, Dhall SS, Haid Jr RW, Rodts Jr GE, Mummaneni PV. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion: Clinical article. Journal of Neurosurgery: Spine. 2011;14(5):619-25.
21. Auffinger BM, Lall RR, Dahdaleh NS, Wong AP, Lam SK, Koski T, et al. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference. PloS one. 2013;8(6):e67408.
22. Epstein NE, Epstein JA. Short Form–36 outcomes following focal 1-and 2-level cervical laminectomy with multilevel instrumented fusion. Surgical neurology. 2006;66(3):264-8.
23. Ding C, Hong Y, Liu H, Shi R, Song Y, Li T. Comparison of cervical disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy. Acta Orthop Belg. 2013;79(3):338-46.
24. Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, Kanbara S, et al. Persistent physical symptoms after laminoplasty: analysis of postoperative residual symptoms in 520 patients with cervical spondylotic myelopathy. Spine. 2012;37(11):932-6.
25. Weiss D, Fried G, Chancellor M, Herbison G, Ditunno J, Staas W. Spinal Cord Injury, and Bladder Recovery. The Journal of Urology. 1998;159(3):1114.
26. Fukuda K, Ozaki T, Tsumura N, Sengoku A, Nomi M, Yanagiuchi A, et al. Neurogenic bladder associated with pure cervical spondylotic myelopathy: clinical characteristics and recovery after surgery. Spine. 2013;38(2):104-11.
27. Misawa T, Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Kitahara J. Neurogenic bladder in patients with cervical compressive myelopathy. Journal of spinal disorders & techniques. 2005;18(4):315-20.
2. Yamazaki S, Kokubun S, Ishii Y, Tanaka Y. Courses of cervical disc herniation causing myelopathy or radiculopathy: an analysis based on computed tomographic discograms. Spine. 2003;28(11):1171-5.
3. Bernhardt M, Hynes R, Blume H, White A. Cervical spondylotic myelopathy. J Bone Joint Surg Am. 1993;75(1):119-28.
4. Hillard VH, Apfelbaum RI. Surgical management of cervical myelopathy: indications and techniques for multilevel cervical discectomy. The Spine Journal. 2006;6(6):S242-S51.
5. Konya D, Ozgen S, Gercek A, Pamir MN. Outcomes for combined anterior and posterior surgical approaches for patients with multisegmental cervical spondylotic myelopathy. Journal of Clinical Neuroscience. 2009;16(3):404-9.
6. Manzano GR, Casella G, Wang MY, Vanni S, Levi AD. A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy. Neurosurgery. 2012;70(2):264-77.
7. Anderson PA, Matz PG, Groff MW, Heary RF, Holly LT, Kaiser MG, et al. Laminectomy and fusion for the treatment of cervical degenerative myelopathy. Journal of Neurosurgery: Spine. 2009;11(2):150-6.
8. Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al. Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy. The Journal of Bone & Joint Surgery. 2013;95(18):1651-8.
9. Furlan JC, Kalsi-Ryan S, Kailaya-Vasan A, Massicotte EM, Fehlings MG. Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases: Clinical article. Journal of Neurosurgery: Spine. 2011;14(3):348-55.
10. Ware-JE J, Sherbourne CD. The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care 1992;30: 473–83.
11. Aitken RC. Measurement of feelings using visual analogue scales. Proceedings of the royal society of medicine. 1969 Oct;62(10):989.
12. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. Journal of manipulative and physiological therapeutics. 1991 Sep;14(7):409-15.
13. Nurjck S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972 Jan 1;95(1):87-100.
14. Brain WR, Northfield D, Wilkinson M. The neurological manifestations of cervical spondylosis. Brain. 1952;75(2):187-225.
15. Epstein N. Efficacy and outcomes of dynamic-plated single-level anterior diskectomy/fusion with additional analysis of comparative costs. Surgical neurology international. 2011;2:9.16. Rhee JM, editor Posterior surgery for cervical myelopathy: laminectomy, laminectomy with fusion, and laminoplasty. Seminars in Spine Surgery; 2007: Elsevier.
17. Yang H-L, Chen G-D, Zhang H-T, Wang L, Luo Z-P. Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease. Clinical Spine Surgery. 2013;26(1):E13-E8.
18. Grosso MJ, Hwang R, Mroz T, Benzel E, Steinmetz MP. Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery: Clinical article. Journal of Neurosurgery: Spine. 2013;18(6):537-44.
19. Singh A, Gnanalingham K, Casey A, Crockard A. Quality of life assessment using the Short Form-12 (SF-12) questionnaire in patients with cervical spondylotic myelopathy: comparison with SF-36. Spine. 2006;31(6):639-43.
20. Highsmith JM, Dhall SS, Haid Jr RW, Rodts Jr GE, Mummaneni PV. Treatment of cervical stenotic myelopathy: a cost and outcome comparison of laminoplasty versus laminectomy and lateral mass fusion: Clinical article. Journal of Neurosurgery: Spine. 2011;14(5):619-25.
21. Auffinger BM, Lall RR, Dahdaleh NS, Wong AP, Lam SK, Koski T, et al. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference. PloS one. 2013;8(6):e67408.
22. Epstein NE, Epstein JA. Short Form–36 outcomes following focal 1-and 2-level cervical laminectomy with multilevel instrumented fusion. Surgical neurology. 2006;66(3):264-8.
23. Ding C, Hong Y, Liu H, Shi R, Song Y, Li T. Comparison of cervical disc arthroplasty with anterior cervical discectomy and fusion for the treatment of cervical spondylotic myelopathy. Acta Orthop Belg. 2013;79(3):338-46.
24. Machino M, Yukawa Y, Hida T, Ito K, Nakashima H, Kanbara S, et al. Persistent physical symptoms after laminoplasty: analysis of postoperative residual symptoms in 520 patients with cervical spondylotic myelopathy. Spine. 2012;37(11):932-6.
25. Weiss D, Fried G, Chancellor M, Herbison G, Ditunno J, Staas W. Spinal Cord Injury, and Bladder Recovery. The Journal of Urology. 1998;159(3):1114.
26. Fukuda K, Ozaki T, Tsumura N, Sengoku A, Nomi M, Yanagiuchi A, et al. Neurogenic bladder associated with pure cervical spondylotic myelopathy: clinical characteristics and recovery after surgery. Spine. 2013;38(2):104-11.
27. Misawa T, Kamimura M, Kinoshita T, Itoh H, Yuzawa Y, Kitahara J. Neurogenic bladder in patients with cervical compressive myelopathy. Journal of spinal disorders & techniques. 2005;18(4):315-20.
| Files | ||
| Issue | Vol 4, No 2 (2018) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v4i2.2956 | |
| Keywords | ||
| Cervical Vertebrae; Intervertebral Disc Degeneration; Spinal Fusion; Patient Outcome Assessment; Quality of Life | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mirzashahi B, Mansouri P, Najafi A, Besharati S, Kouchakinejad MT, Mohseni A, Rezaeian P. Functional and Quality of Life Outcomes of Surgery for Degenerative Cervical Myelopathy: A Quality Improvement Study. J Orthop Spine Trauma. 2020;4(2):19-22.
