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

• Published in: Journal of neurosurgery. Spine Vol. 36; no. 4; pp. 568 - 574
• Main Authors: Asuzu, David T, Yun, Jonathan J, Alvi, Mohammed Ali, Chan, Andrew K, Upadhyaya, Cheerag D, Coric, Domagoj, Potts, Eric A, Bisson, Erica F, Turner, Jay D, Knightly, Jack J, Fu, Kai-Ming, Foley, Kevin T, Tumialan, Luis, Shaffrey, Mark, Bydon, Mohamad, Mummaneni, Praveen V, Park, Paul, Meyer, Scott, Asher, Anthony L, Gottfried, Oren N, Than, Khoi D, Wang, Michael Y, Buchholz, Avery L
• Format: Journal Article
• Language: English
• Published: United States 01-04-2022
• Subjects: Cervical Vertebrae - surgery; Decompression, Surgical - methods; Humans; Postoperative Period; Prospective Studies; Spinal Cord Diseases - diagnosis; Treatment Outcome; fusion; multicenter registry; weakness; pain; clinical scores; cervical myelopathy; symptom duration; functional outcomes; cervical spondylosis; surgical decompression
• ISSN: 1547-5654; 1547-5646
• DOI: 10.3171/2021.7.SPINE21590

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.
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.
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).
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.