Myelopathy disability index: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy

• Published in: European spine journal Vol. 32; no. 2; pp. 584 - 589
• Main Authors: Pons Carreto, Alba, Ramírez Valencia, Manuel, de García Frutos, Ana, Khoudeir Avila, Andrea, Montesinos Magraner, Lluisa, Nuñez-Pereira, Susana, Haddad, Sleiman, Pellisé Urquiza, Ferran
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2023; Springer Nature B.V
• Subjects: Age; Bladder; Bone Marrow Diseases; Central nervous system diseases; Cervical Vertebrae; Cross-Sectional Studies; Data collection; Female; Humans; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Original Article; Orthopedics; Patients; Prospective Studies; Quality of Life; Spinal cord; Spinal Cord Diseases - diagnosis; Surgery; Surgical Orthopedics; Treatment Outcome; Degenerative cervical myelopathy; Myelopathy disability index; Modified Japanese Orthopedic Association; Severity measurement
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-022-07506-2

Purpose
To find the cut-off values in the Myelopathy Disability Index (MDI) that will allow us to classify the severity of Degenerative Cervical Myelopathy (DCM) into mild, moderate and severe.
Methods
Cross-sectional study with prospective data collection, with a total of 64 patients diagnosed with Degenerative Cervical Myelopathy (DCM). Anthropometric, diagnostic, neurological, functional and quality of life variables were collected. A Receiver Operating Curve (ROC) was performed. The cut-off points were validated by comparing the functional status of patients in the 3 groups and their Nurick scores.
Results
Sixty-four patients (23 women) with a mean age of 61.97 (SD 11.57) participated in this study. The majority of patients were Nurick I (28.13%) and Nurick II (32.81%). The medium MDI was 7.36 (SD 6.66) and the mJOA was 14.08 (SD 2.57). The mild-moderate cut-off value was between 4 and 5, with an Area Under the Curve (AUC) of 0.805, sensitivity of 0.853 and specificity of 0.6. For moderate-severe, the cut-off value obtained was between 7 and 8, with an AUC of 0.862, sensitivity of 0.857 and specificity of 0.684. Patients with greater severity had significantly lower functionality, with a
P
-value of 0.004 in the 30 Metre Walking Test and 0.005 in the Nine-Hole Peg Test. Established severity groups were also significantly related to the different categories of the Nurick score (
P
-value = 0.000).
Conclusion
MDI values between 0 and 4 correspond to mild DCM, between 5 and 7 would be moderate DCM and from 8 to 30 indicate severe DCM.