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  • Surgical Decompression for Cervical Myelopathy Improves Hand Function: A Prospective Observational Study

    Final Number:

    Kaith Almefty MD; Amy Muma OT; Jay D. Turner MD, PhD; Eduardo Martinez del Campo MD; Randall Hlubek; Timothy R Smith MD PhD MPH; Steve W. Chang MD; Randall W. Porter MD; Taro Kaibara; Udaya K. Kakarla MD; Nicholas Theodore MD, FACS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Cervical myelopathy is a relatively common disease that can affect numerous functional domains. Surgical decompression has been demonstrated to improve functional outcomes. We performed a prospective observational study with a focus on hand impairment in patients with cervical myelopathy to evaluate the degree of both pre-operative impairment and post-operative improvement following surgical decompression.

    Methods: All patients treated, at a single center between July 2013 and May 2014, for cervical myelopathy were recruited for enrollment. Patients performed three tests, Jamar Dynamometer, Palmar Pinch gauge test, and Nine-Hole-Peg test, pre-operatively and 6-8 weeks post-operatively to evaluate hand strength and dexterity. Pre-operative test results were compared to standardized population means for each domain to access the degree of pre-operative impairment. Pre-operative and post-operative test results were compared to evaluate for any potential surgical benefit.

    Results: 33 of 38 enrolled patients completed pre- and post-operative testing. The average patient age was 58.1 years and 52% of patients were male. 70%, 61%, and 91% of patients scored one standard deviation lower than population based means in at least one hand for the Jamar Dynamometer, Palmar Pinch gauge test, and Nine-Hole-Peg test, respectively. Myelopathic patients had significantly worse pre-operative hand function in both hands and in each of the tested domains compared to population controls (p<0.05). 52%, 48%, and 91% of patients achieved clinical benefit in at least one hand in the three tests, respectively. Post-operatively, patients had significant improvement in bilateral hand function across each test (p<0.05) with the exception of the right-hand Nine-Hole-Peg-Test.

    Conclusions: Surgical decompression significantly improves patient hand strength and dexterity in patients with cervical myelopathy.

    Patient Care: This study will help to understand the degree of impairment in hand function secondary to cervical myelopathy and the degree to which it may improve with surgery.

    Learning Objectives: 1. Understand the pre-operative hand impairments secondary to cervical myelopathy 2. Understand the effect of surgery on hand function in patients with cervical myelopathy

    References: Suzuki, Akinobu, et al. "Recovery process following cervical laminoplasty in patients with cervical compression myelopathy: prospective cohort study."Spine 34.26 (2009): 2874-2879. Iwasaki M, Kawaguchi Y, Kimura T, et al. Long-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up. J Neurosurg 2002;96:180–9 Seichi A, Takeshita K, Ohishi I, et al. Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine 2001;26:479–87. Satomi K, Nishu Y, Kohno T, et al. Long-term follow-up studies of open-door expansive laminoplasty for cervical stenotic myelopathy. Spine 1994;19:507–10. Olindo, Stephane, et al. Quantitative assessment of hand disability by the Nine-Hole-Peg test (9-HPT) in cervical spondylotic myelopathy. Journal of Neurology, Neurosurgery & Psychiatry 79.8 (2008): 965-967. Mathiowtz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and Pinch Strength: Normative Data for Adults. Arch Phys Rehabil 1985,66:69-74.

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