Impact of postsurgical rehabilitation on outcomes for degenerative cervical myelopathy

Mahmudur Rahman Neurosurgery, and

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Anjishnu Banerjee Departments of Biostatistics,

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Yushan Yang Departments of Biostatistics,

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Evanka Annyapu Neurosurgery, and

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Andrew L. DeGroot Neurosurgery, and

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Benjamin Best Neurosurgery, and

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Diane W. Braza Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin

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Marjorie C. Wang Neurosurgery, and

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Aditya Vedantam Neurosurgery, and

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OBJECTIVE

Despite widespread use, there is limited evidence to support postsurgical rehabilitation to enhance neurological recovery after surgery for degenerative cervical myelopathy (DCM). Outcomes research for DCM seldom accounts for the effect of postsurgical rehabilitation. The aim of this study was to quantify the impact of postsurgical rehabilitation on outcomes after surgery for DCM.

METHODS

This was a retrospective analysis of prospectively collected data from a single center. The study enrolled 66 patients who underwent spinal surgery for DCM. In addition to patient demographic, imaging, and surgical data, chart review was performed to document the timing, type, duration, and outcomes of postsurgical rehabilitation therapy. Outcomes were collected prospectively, including the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI) score, and SF-36 physical component summary (PCS) score. Linear regression models were created to determine the independent effects of type and timing of postsurgical occupational therapy (OT) and physical therapy (PT) on outcomes.

RESULTS

A total of 66 patients were included in the analysis. Multivariate regression analysis showed that postsurgical OT was associated with significantly greater improvement in 12-month SF-36 PCS scores (p = 0.009) and mJOA scores (p = 0.019). In the subset of patients who received therapy, delayed therapy (> 42 days after surgery) compared to early therapy (< 42 days after surgery) was associated with less improvement in SF-36 PCS scores (p = 0.03).

CONCLUSIONS

Postsurgical outpatient rehabilitation was independently associated with improved postsurgical outcomes within the 1st year after surgery for DCM, and early therapy (< 42 days) was associated with superior outcomes compared to delayed therapy. This is one of the first studies to use a prospective database to demonstrate an independent effect for postsurgical rehabilitation on outcomes after surgery for DCM.

ABBREVIATIONS

ASA = American Society of Anesthesiologists Physical Status Classification System; DCM = degenerative cervical myelopathy; mJOA = modified Japanese Orthopaedic Association; NDI = Neck Disability Index; OT = occupational therapy; PCS = physical component summary; PT = physical therapy; SCI = spinal cord injury.
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