PMID- 35901760 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 37 IP - 5 DP - 2022 Nov 1 TI - Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study. PG - 758-766 LID - 10.3171/2022.5.SPINE211425 [doi] AB - OBJECTIVE: While surgical decompression is an important treatment modality for cervical spondylotic myelopathy (CSM), it remains unclear if the severity of preoperative myelopathy status affects potential benefit from surgical intervention and when maximum postoperative improvement is expected. This investigation sought to determine if retrospective analysis of prospectively collected patient-reported outcomes (PROs) following surgery for CSM differed when stratified by preoperative myelopathy status. Secondary objectives included assessment of the minimal clinically important difference (MCID). METHODS: A total of 1151 patients with CSM were prospectively enrolled from the Quality Outcomes Database at 14 US hospitals. Baseline demographics and PROs at baseline and 3 and 12 months were measured. These included the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI), quality-adjusted life-years (QALYs) from the EQ-5D, and visual analog scale from the EQ-5D (EQ-VAS). Patients were stratified by preoperative myelopathy severity using criteria established by the AO Spine study group: mild (mJOA score 15-17), moderate (mJOA score 12-14), or severe (mJOA score < 12). Univariate analysis was used to identify demographic variables that significantly varied between myelopathy groups. Then, multivariate linear regression and linear mixed regression were used to model the effect of severity and time on PROs, respectively. RESULTS: For NDI, EQ-VAS, and QALY, patients in all myelopathy cohorts achieved significant, maximal improvement at 3 months without further improvement at 12 months. For mJOA, moderate and severe myelopathy groups demonstrated significant, maximal improvement at 3 months, without further improvement at 12 months. The mild myelopathy group did not demonstrate significant change in mJOA score but did maintain and achieve higher PRO scores overall when compared with more advanced myelopathy cohorts. The MCID threshold was reached in all myelopathy cohorts at 3 months for mJOA, NDI, EQ-VAS, and QALY, with the only exception being mild myelopathy QALY at 3 months. CONCLUSIONS: As assessed by statistical regression and MCID analysis, patients with cervical myelopathy experience maximal improvement in their quality of life, neck disability, myelopathy score, and overall health by 3 months after surgical decompression, regardless of their baseline myelopathy severity. An exception was seen for the mJOA score in the mild myelopathy cohort, improvement of which may have been limited by ceiling effect. The data presented here will aid surgeons in patient selection, preoperative counseling, and expected postoperative time courses. FAU - Berlin, Connor AU - Berlin C AD - 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Marino, Alexandria C AU - Marino AC AD - 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 2Department of Neurological Surgery, University of California, San Francisco, California. FAU - Uribe, Juan AU - Uribe J AD - 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. FAU - Tumialan, Luis M AU - Tumialan LM AD - 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. FAU - Turner, Jay AU - Turner J AD - 3Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona. FAU - Wang, Michael Y AU - Wang MY AD - 4Department of Neurological Surgery, University of Miami, Miami, Florida. FAU - Park, Paul AU - Park P AD - 5Department of Neurological Surgery, University of Michigan, Ann Arbor, Michigan. FAU - Bisson, Erica F AU - Bisson EF AD - 6Department of Neurosurgery, University of Utah, Salt Lake City, Utah. FAU - Shaffrey, Mark AU - Shaffrey M AD - 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. FAU - Gottfried, Oren AU - Gottfried O AD - 7Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina. FAU - Than, Khoi D AU - Than KD AD - 7Department of Neurosurgery, Division of Spine, Duke University Medical Center, Durham, North Carolina. FAU - Fu, Kai-Ming AU - Fu KM AD - 8Department of Neurological Surgery, Weill Cornell Medicine, New York City, New York. FAU - Foley, Kevin AU - Foley K AD - 9Department of Neurosurgery, University of Tennessee, Memphis, Tennessee. FAU - Chan, Andrew K AU - Chan AK AD - 2Department of Neurological Surgery, University of California, San Francisco, California. FAU - Bydon, Mohamad AU - Bydon M AD - 10Department of Neurosurgery, Mayo Clinic Neuro-Informatics Lab, Mayo Clinic, Rochester, Minnesota. FAU - Alvi, Mohammed Ali AU - Alvi MA AD - 10Department of Neurosurgery, Mayo Clinic Neuro-Informatics Lab, Mayo Clinic, Rochester, Minnesota. FAU - Upadhyaya, Cheerag AU - Upadhyaya C AD - 11Marion Bloch Neuroscience Institute's Spine Program, Saint Luke Health System, Kansas City, Missouri. FAU - Coric, Domagoj AU - Coric D AD - 12Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina. FAU - Asher, Anthony AU - Asher A AD - 12Carolina Neurosurgery & Spine Associates, Carolinas Medical Center, Charlotte, North Carolina. FAU - Potts, Eric A AU - Potts EA AD - 13Goodman Campbell Brain and Spine, Indianapolis, Indiana; and. FAU - Knightly, John AU - Knightly J AD - 14Atlantic Neurosurgical Specialists, Altair Health Spine & Wellness Center, Morristown, New Jersey. FAU - Meyer, Scott AU - Meyer S AD - 14Atlantic Neurosurgical Specialists, Altair Health Spine & Wellness Center, Morristown, New Jersey. FAU - Buchholz, Avery AU - Buchholz A AD - 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia. LA - eng PT - Journal Article DEP - 20220617 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - cervical OT - decompression OT - myelopathy OT - spine OT - spondylotic OT - surgery EDAT- 2022/07/29 06:00 MHDA- 2022/07/29 06:01 CRDT- 2022/07/28 18:25 PHST- 2021/11/08 00:00 [received] PHST- 2022/05/05 00:00 [accepted] PHST- 2022/07/29 06:01 [medline] PHST- 2022/07/29 06:00 [pubmed] PHST- 2022/07/28 18:25 [entrez] AID - 10.3171/2022.5.SPINE211425 [doi] PST - epublish SO - J Neurosurg Spine. 2022 Jun 17;37(5):758-766. doi: 10.3171/2022.5.SPINE211425. Print 2022 Nov 1.