Volume 1 | Issue 1 | October 2020-March 2021 | page: 13-18 | Subir N. Jhaveri, Samir J. Patel, Sharan S. Jhaveri, Nancy Modi, Jignasu Yagnik
Authors: Subir N. Jhaveri [1], Samir J. Patel [1], Sharan S. Jhaveri [1][2], Nancy Modi [1], Jignasu Yagnik [3]
[1] Subir Jhaveri’s Spine Hospital, Satellite, Ahmedabad, Gujrat, India.
[2] Smt. NHL Municipal Medical College, Ellisbridge, Ahmedabad, Gujrat, India.
[3] Indukaka Ipcowala Institute of Management (I2IM), Charotar University of Science & Technology (CHARUSAT), Changa, Anand, Gujrat, India.
Address of Correspondence
Dr. Subir Jhaveri,
Spine Hospital, First floor, Jyoti Plaza, Shyamal cross roads, 132 feet ring road, Satellite, Ahmedabad, Gujrat, India.
E-mail: subirjhaveri@yahoo.com
Abstract
Study Design: This was a retrospective case series.
Objective: The objective of the study was to assess the surgical outcomes of patients with cervical myelopathy, using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).
Summary of Background Data: Degenerative cervical myelopathy (DCM) is a leading cause of morbidity. Patients present with spasticity, gait imbalance, and loss of fine motor function. Most patients present early; however, few manage with disability for years and present late.
Methods: Fifty-two consecutive patients underwent surgery for cervical myelopathy from 2008 to 2013; however, detailed follow-up was available in only 42 patients. Thirty-nine patients were ambulatory, while 3 were non-ambulatory at the outset. Nineteen patients underwent anterior surgery and 23 patients underwent posterior surgery. Frankel, Nurick grades, Neck Disability Index (NDI), and JOACMEQ scores were recorded at time of admission, 6, 12, 24, and 52 weeks, and then annually. Outcomes at final follow-up were included for statistical analysis.
Results: Thirty-four (81%) patients improved, 4 (9.5%) patients remained static, and 4 (9.5%) patients worsened according to Nurick scale. Nurick grades improved from 3.52 to 1.64. Mean NDI scores improved from 42.28 to 20.28. Analyzing the JOACMEQ scores, cervical spine function improved in 15 (35.7%), upper extremity (UE) function improved in 33 (78.6%) patients, while lower extremity (LE) function improved in 32 (76.2%) patients. Bladder function improved in 17 (40.47%). Quality of life improved in 37 (88.1%) patients. LE improved more than UE, in the younger (<45 years) group, and in those with subaxial myelopathy. Pre-operative symptoms greater than 12 months had a negative impact on outcome. Pre-operative neurology, approach, and instrumentation did not impact outcomes. Four (9.5%) patients developed major neurological deficit, 4 (9.5%) patients had C5 deltoid palsy, while 1 patient had recurrent laryngeal palsy.
Conclusion: Surgical results of DCM are highly satisfactory, even in late cases. LE improved more than UE in subaxial cases and in younger individuals. Surgical intervention within 12 months of symptoms affects outcome positively.
Keywords: Degenerative cervical myelopathy, cervical spondylotic myelopathy, surgical outcomes, JOA scores, JOACMEQ scores, ossified posterior longitudinal ligament, cervical discectomy, cervical laminectomy, iliac crest bone graft, anterior cervical discectomy and fusion, artificial cervical disc replacement, lateral mass screws.
Level of Evidence: 4.
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| How to Cite this Article: Jhaveri SN, Patel SJ, Jhaveri SS, Modi N, Yagnik J| Surgical Outcomes in Patients Operated for Cervical Myelopathy using Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire| Back Bone: The Spine Journal | October 2020-March 2021; 1(1): 13-18. |
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