Introduction: Patients with cervical spondylotic myelopathy CSM) may be severely impaired, have reduced quality of life and present with deleterious signs. Patients with severe myelopathy often improve following surgery; however, they may have varying prognoses depending on a variety of factors. It is important to predict outcome in these patients and use this knowledge to manage patients’ expectations. This study aims to determine the most important clinical predictors of surgical outcome in patients with severe CSM.
Methods: Of the 757 patients enrolled in the CSM-North America or International studies, 254 (33.55%) presented with severe myelopathy with a modified Japanese Orthopaedic Association (mJOA) score <12 points. A prediction model was developed to distinguish between patients who improve to mild or moderate myelopathy postoperatively (mJOA=12) and those who remain significantly impaired (mJOA<12). Univariate analyses evaluated the relationship between this outcome and various clinical predictors. Multivariate logistic regression was used to formulate the final prediction model.
Results: Our cohort consisted of 153 men and 101 women with ages ranging from 28 to 86 (mean: 60.09±12.06 years). The mean preoperative mJOA was 9.42±1.67. Based on univariate analysis, baseline severity score (OR: 1.35, p=0.012) and lower limb spasticity (OR: 0.22, p=0.0006) were the only significant predictors of a mJOA=12. The final model consisted of four statistically significant and clinically relevant predictors: baseline severity score (OR: 1.40, p=0.0016), duration of symptoms (OR: 0.71, p=0.027) and co-morbidity score (OR: 0.80p=0.040) and the neurological sign “lower limb spasticity” (OR: 0.16, p=0.0016). The AUC for this model was 0.75 (95% C.I.: 0.67-0.83).
Conclusions: Severe patients were more likely to achieve a score =12 on the mJOA if they had a higher mJOA score and a shorter duration of symptoms preoperatively; were healthier as reflected by number and severity of co-morbidities; and did not have lower limb spasticity.
Patient Care: This study aims to determine the most important clinical predictors of surgical outcome in patients with severe CSM.
Learning Objectives: To determine the most important clinical predictors of surgical outcome in patients with severe CSM.