Functional outcomes assessment for cervical degenerative disease

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  • 1 Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California;
  • 2 Division of Neurological Surgery, University of Alabama, Birmingham, Alabama;
  • 3 Departments of Orthopaedic Surgery and
  • 11 Neurological Surgery, University of Wisconsin, Madison, Wisconsin;
  • 4 Department of Neurosurgery, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts;
  • 5 Department of Neurosurgery, University of Medicine and Dentistry of New Jersey—New Jersey Medical School, Newark, New Jersey;
  • 6 Department of Neurological Surgery, Neurological Institute, Columbia University, New York, New York;
  • 7 Department of Neurosurgery, University of California at San Francisco, California;
  • 8 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • 9 Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York; and
  • 10 Department of Orthopaedic Surgery, Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, Hershey, Pennsylvania
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Object

The objective of this systematic review was to use evidence-based medicine to identify valid, reliable, and responsive measures of functional outcome after treatment for cervical degenerative disease.

Methods

The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to functional outcomes. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I–III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.

Results

Myelopathy Disability Index, Japanese Orthopaedic Association scale, 36-Item Short Form Health Survey, and gait analysis were found to be valid and reliable measures (Class II) for assessing cervical spondylotic myelopathy. The Patient-Specific Functional Scale, the North American Spine Society scale, and the Neck Disability Index were found to be reliable, valid, and responsive (Class II) for assessing radiculopathy for nonoperative therapy. The Cervical Spine Outcomes Questionnaire was a reliable and valid method (Class II) to assess operative therapy for cervical radiculopathy.

Conclusions

Several functional outcome measures are available to assess cervical spondylotic myelopathy and cervical radiculopathy.

Abbreviations used in this paper: CSM = cervical spondylotic myelopathy; CSOQ = Cervical Spine Outcomes Questionnaire; EMS = European Myelopathy Score; ICC = intraclass correlation coefficient; JOA = Japanese Orthopaedic Association; MDI = Myelopathy Disability Index; NASS = North American Spine Society; NDI = Neck Disability Index; ODI = Oswestry Disability Index; PSFS = Patient-Specific Functional Scale; SF-12 = 12-Item Short Form Health Survey; SF-36 = 36-Item Short Form Health Survey.

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Contributor Notes

Address correspondence to: Paul G. Matz, M.D., Neurosurgery and Neurology, LLC, 232 South Woods Mill Road, Chesterfield, Missouri 63017. email: matzpg@yahoo.com.
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