• Neurosurgery · Feb 2023

    Review Observational Study

    Timing of Recovery After Surgery for Patients With Degenerative Cervical Myelopathy: An Observational Study From the Canadian Spine Outcomes and Research Network.

    • Nathan Evaniew, Matthew Coyle, Y Raja Rampersaud, Christopher S Bailey, W Bradley Jacobs, David W Cadotte, Kenneth C Thomas, Najmedden Attabib, Jérôme Paquet, Andrew Nataraj, Sean D Christie, Michael H Weber, Philippe Phan, Raphaële Charest-Morin, Charles G Fisher, Hamilton Hall, Greg McIntosh, and Nicolas Dea.
    • Spine Program, University of Calgary, Calgary, Alberta, Canada.
    • Neurosurgery. 2023 Feb 1; 92 (2): 271282271-282.

    BackgroundThe time course over which postoperative neurological recovery occurs after surgery for degenerative cervical myelopathy occurs is poorly understood.ObjectiveTo determine the time point at which patients experience significant neurological improvement.MethodsWe reviewed data from an ongoing prospective multicenter cohort study. We measured neurological function at 3 months, 1 year, and 2 years after surgery using the modified Japanese Orthopedic Association (mJOA) scale. We implemented minimal clinical important differences (MCIDs) to guide interpretation of mJOA scores, and we used 1-way analysis of variance to compare changes between follow-up intervals.ResultsAmong 330 patients, the mean overall mJOA improved from 12.9 (SD 2.6) to 14.6 (SD 2.4) at 3 months, 14.7 (SD 2.4) at 1 year, and 14.8 (SD 2.5) at 2 years. The difference in means was statistically significant (P < .01) at the interval from baseline to 3 months postoperatively, but not from 3 months to 1 year or 1 year to 2 years. The MCID was reached by 161 patients at 3 months, 32 more at 1 year, and 15 more at 2 years, with a statistically significant difference only at 3 months. Patients with moderate or severe disease reached the MCID more frequently than those with mild disease.ConclusionAmong patients who underwent surgery for degenerative cervical myelopathy, most significant neurological improvement occurred by 3 months after surgery. These findings will facilitate valid discussions about postoperative expectations during shared clinical decision making between patients and their surgeons.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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