Association of ≥ 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database

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  • 1 Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;
  • | 2 Surgical Neurology Branch, National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland;
  • | 3 Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;
  • | 4 Department of Neurosurgery, University of Utah, Salt Lake City, Utah;
  • | 5 Department of Neurosurgery, University of California, San Francisco, San Francisco, California;
  • | 6 Saint Luke’s Neurological and Spine Surgery, Kansas City, Missouri;
  • | 7 Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina;
  • | 8 Goodman Campbell Brain and Spine, Carmel, Indiana;
  • | 9 Barrow Neurological Institute, Phoenix, Arizona;
  • | 10 Altair Health Spine and Wellness, Morristown, New Jersey;
  • | 11 Department of Neurological Surgery, Weill Cornell Medicine, New York, New York;
  • | 12 Department of Neurosurgery, University of Tennessee, Memphis, Tennessee;
  • | 13 Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;
  • | 14 Department of Neurological Surgery, Duke University Medical Center, Durham, North Carolina; and
  • | 15 Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida
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OBJECTIVE

Degenerative cervical myelopathy (DCM) results in significant morbidity. The duration of symptoms prior to surgical intervention may be associated with postoperative surgical outcomes and functional recovery. The authors’ objective was to investigate whether delayed surgical treatment for DCM is associated with worsened postoperative outcomes.

METHODS

Data from 1036 patients across 14 surgical centers in the Quality Outcomes Database were analyzed. Baseline demographic characteristics and findings of preoperative and postoperative symptom evaluations, including duration of symptoms, were assessed. Postoperative functional outcomes were measured using the Neck Disability Index (NDI) and modified Japanese Orthopaedic Association (mJOA) scale. Symptom duration was classified as either less than 12 months or 12 months or greater. Univariable and multivariable regression were used to evaluate for the associations between symptom duration and postoperative outcomes.

RESULTS

In this study, 513 patients (49.5%) presented with symptom duration < 12 months, and 523 (50.5%) had symptoms for 12 months or longer. Patients with longer symptom duration had higher BMI and higher prevalence of anxiety and diabetes (all p < 0.05). Symptom duration ≥ 12 months was associated with higher average baseline NDI score (41 vs 36, p < 0.01). However, improvements in NDI scores from baseline were not significantly different between groups at 3 months (p = 0.77) or 12 months (p = 0.51). Likewise, the authors found no significant differences between groups in changes in mJOA scores from baseline to 3 months or 12 months (both p > 0.05).

CONCLUSIONS

Surgical intervention resulted in improved mJOA and NDI scores at 3 months, and this improvement was sustained in both patients with short and longer initial symptom duration. Patients with DCM can still undergo successful surgical management despite delayed presentation.

ABBREVIATIONS

ACDF = anterior cervical discectomy and fusion; CAD = coronary artery disease; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; DBM = demineralized bone matrix; DCM = degenerative cervical myelopathy; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; PVD = peripheral vascular disease; QOD = Quality Outcomes Database; SES = socioeconomic status; VAS = visual analog scale.

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