Multimodal assessment after surgery for cervical spondylotic myelopathy

Joseph T. King Jr. M.D., M.S.C.E. 1 , John J. Moossy M.D. 1 , Joel Tsevat M.D., M.P.H. 1 , and Mark S. Roberts M.D., M.P.P. 1
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  • 1 Section of Neurosurgery, Veterans Administration Connecticut Healthcare System, West Haven; Department of Neurosurgery, Yale University, New Haven, Connecticut; Section of Neurosurgery, Surgical Service Line, Veterans Affairs Pittsburgh Healthcare System; Department of Neurological Surgery, and Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania; Section of Outcomes Research and Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Internal Medicine, and Center for Clinical Effectiveness, Institute for Health Policy and Health Services Research, University of Cincinnati Medical Center, Cincinnati; and Veterans Affairs Medical Center, Cincinnati, Ohio
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Object. Investigators reporting decompressive surgery to treat patients with cervical spondylotic myelopathy (CSM) have described inconsistent benefits. In the present study the authors used three types of outcomes instruments to assess the results of CSM surgery.

Methods. The authors collected prospective baseline and 6-month follow-up data in a cohort of 62 patients with CSM. Data collection included those pertaining to demographics; symptoms; physical findings; myelopathy severity; health status measured with the Short Form—36; and health values according to the standard gamble, time trade-off, visual analog scale, and willingness to pay. Rank-order methods were used to compare surgical and nonsurgical patients, and multivariate regression techniques adjusting for baseline characteristics were performed to examine the effects of surgery.

During the study period, 28 patients underwent surgery, 34 did not, and there were no baseline differences between the two groups in demographics, symptoms, myelopathy scores, health status, or health values (p ≥ 0.120 in all domains); there was a greater prevalence of hand intrinsic muscle atrophy (p = 0.035) and Hoffmann sign (p = 0.006) in the surgery-treated group. Neither raw comparisons nor regression analyses showed a consistent surgery-related benefit. There were sporadic associations between worse outcomes and older patients, higher income, Babinski sign, longer duration of CSM symptoms, hand clumsiness, lower-extremity numbness, and multilevel surgery (p ≤ 0.049 for all).

Conclusions. Analysis of results obtained in the 62 patients with CSM failed to show a surgery-related benefit despite the use of three classes of outcomes instruments. Patient demographics, symptoms, physical signs, and the surgical approach may explain some of the variation in outcomes in patients with CSM.

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Contributor Notes

Address reprint requests to: Joseph T. King Jr., M.D., M.S.C.E., Section of Neurosurgery, Veterans Administration Connecticut Healthcare System/112, 950 Campbell Avenue, West Haven, Connecticut 06516. email: Joseph.KingJr@med.va.gov.
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