Introduction: Treatment of cervical myelopathy (CSM) has traditionally been surgical, in patients with mild CSM (Modified Japanese Orthopaedic Association (MJOA) scale score > 15) non-operative management has been proposed. The purpose of this study was to evaluate which factors predicted selection for surgery in patients with mild CSM.
Methods: This is a prospective cohort study of patients with CSM. Patients were recruited from 7 Canadian centers and data was gathered in the Canadian Spine Outcomes Research Network (CSORN) database. Demographic, clinical, and health related quality of life(HRQOL) data was collected on all patients at baseline. Multivariate logistic regression modeling was used to identify predictors of surgical intervention.
Results: Three hundred sixty patients were enrolled, of which 96 patients were categorized as mild CSM. Eighty-three (86.4%) were treated surgically and 13 (13.6%) were treated conservatively. Sixty of those with mild myelopathy (62.5%) were male and the mean age was 55.7 (SD 12.6) years old. There were no differences between surgical and non-surgical patients with respect to BMI, duration of symptoms, medical comorbidities and age. MJOA scores were higher in the non-operative group (17.0 SD 0.89 vs. 15.0 SD 0.93, p=0.002). Patients who underwent surgery had higher baseline neck pain (5.18 vs. 4.53) and higher disability (NDI) (35.03 vs. 33.87) scores which did not reach statistical significance. Multivariate analysis revealed that the selection of patients for surgical intervention was predicted by symptoms of less than one year duration, higher neck pain scores, lower quality of life scores (EQ5D), and higher disability (NDI) scores.
Conclusions: Patients who were treated surgically for mild CSM did not differ from those treated non-operatively with respect to demographic or radiographic parameters. After adjusted analysis, patients were more likely to have surgical intervention if duration of symptoms was shorter and they had worse pain and quality of life scores.
Patient Care: This research will be able to provide better understanding of the patterns associated with selecting patients for surgical intervention for mild CSM. This will better allow for surgeons to select patients that would benefit from a trial of non-operative management in the form of supervised rehabilitation, and avoid the need for surgical intervention.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe non-operative management strategies for patients with mild CSM, 2) Understand predictors for surgical intervention in patients with mild CSM 3) Understand the role of non-operative versus surgical intervention in patients with mild CSM