How long, on average, does it take for patients to realize the maximum benefit from their cervical spondylotic myelopathy after surgical decompression treatment?
A new study, “Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study” which was published online on June 17, 2022, in the Journal of Neurosurgery, has answers.
The research team from 14 of the top spine research institutions in the United States enrolled 1,151 patients into this study and stratified the group according to the preoperative level of myelopathy severity using criteria established by the AO Spine group: Mild (mJOA score 15-17), moderate (mJOA score 12-14), or severe (mJOA score less than 12).
The 24 top surgeon/scientists (see list at the end of this short article) reported that all patients in the study reached maximal improvement in their quality of life, neck disability, myelopathy score, and overall health within three months (or, put another way, 90 days) following surgical decompression, regardless of myelopathy severity.
The team also collected data for other outcome measures including Neck Disability Index (NDI), quality-adjusted life-years (QALYs) from the EQ-5D, and Visual Analogue Scale from the EQ-5D (EQ-VAS). And the results from those scores also provided evidence that all myelopathy cohorts achieved significant improvements after surgical decompression.
Data also showed that the mild myelopathy group did not demonstrate significant change in mJOA scores but did maintain and achieve higher patient-reported outcomes scores overall when compared with more advanced myelopathy cohorts. The Minimal Clinically Important Difference threshold was reached in all myelopathy cohorts at three months for mJOA, NDI, EQ-VAS, and QALY, with the only exception being mild myelopathy QALY at three months.
There was, however, was one exception noted: using the modified Japanese Orthopaedic Association (mJOA) score in the mild myelopathy group, the research group said that the results may be have a ceiling effect.
The study findings “will aid surgeons in patient selection, preoperative counseling, and expected postoperative time courses,” wrote the principal authors of this important study.
The Research Team and Their Affiliations
- Connor Berlin, M.D., Alexander C. Marino, M.D., Mark Shaffrey, M.D., and Avery Buchholz, M.D., M.P.H., of University of Virginia
- Praveen V. Mummanen, M.D., M.B.A, and Andrew K. Chan, M.D., of the University of California
- Juan Uribe, M.D., Luis M. Tumialian, M.D., Jay Turner, M.D., Ph.D. of St. Joseph’s Hospital and Medical Center in Phoenix, Arizona
- Michael Y. Wang, M.D., of the University of Miami, Miami, Florida
- Paul Park, M.D. of University of Michigan
- Erica F. Bisson, M.D., M.P.H, of University of Utah
- Oren Gottfried, M.D. and Khoi D. Than M.D., of Duke University Medical Center, Durham, North Carolina
- Kai-Ming Fu, M.D., Ph.D. of Weill Cornell Medicine, New York, New York
- Kevin Foley, M.D., of the University of Tennessee
- Mohamad Bydon, M.D. and Mohammed Ali Alvi, M.B.B.S., M.S., of the Mayo Clinic
- Cheerag Upadhyaayr, M.D., of Saint Luke Health System, Kansas City, Missouri
- Domagoj Coric, M.D, and Anthony Asher, M.D., of Carolina Neurosurgery & Spine Associates in Charlotte, North Carolina
- Eric A. Potts, M.D. of Goodman Campbell Brain and Spine, Indianapolis, Indiana
- John Knightly, M.D., and Scott Meyer, M.D. of Atlantic Neurosurgical Specialists, Altar Health Spine & Wellness Center, Morristown, New Jersey.
