PMID- 37660898 OWN - NLM STAT- MEDLINE DCOM- 20231218 LR - 20240123 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 24 IP - 1 DP - 2024 Jan TI - Clinical outcome of surgical management of mild cervical compressive myelopathy based on minimum clinically important difference. PG - 68-77 LID - S1529-9430(23)03364-8 [pii] LID - 10.1016/j.spinee.2023.08.013 [doi] AB - BACKGROUND CONTEXT: Cervical compressive myelopathy (CCM), caused by cervical spondylosis (cervical spondylotic myelopathy [CSM]) or ossification of the posterior longitudinal ligament (OPLL), is a common neurological disorder in the elderly. For moderate/severe CCM, surgical management has been the first-line therapeutic option. Recently, surgical management is also recommended for mild CCM, and a few studies have reported the surgical outcome for this clinical population. Nonetheless, the present knowledge is insufficient to determine the specific surgical outcome of mild CCM. PURPOSE: To examine the surgical outcomes of mild CCM while considering the minimum clinically important difference (MCID). STUDY DESIGN: Retrospective study. PATIENT SAMPLE: Patients who underwent subaxial cervical surgery for CCM caused by CSM and OPLL between 2013 and 2022 were enrolled. OUTCOME MEASURES: The Japanese Orthopedic Association score (JOA score) was employed as the clinical outcomes. Based on previous reports, the JOA score threshold to determine mild myelopathic symptoms was set at >/=14.5 points, and the MCID of the JOA score for mild CCM was set at 1 point. METHODS: The patients with a JOA score of >/=14.5 points at baseline were stratified into the mild CCM and were examined while considering the MCID. The mild CCM cohort was dichotomized into the improvement group, including the patients with an achieved MCID (JOA score >/=1 point) or with a JOA score of 17 points (full mark) at 1 year postoperatively, and the nonimprovement group, including the others. Demographics, symptomatology, radiographic findings, and surgical procedure were compared between the two groups and studied using the receiver operating characteristic (ROC) curve. RESULTS: Of 335 patients with CCM, 43 were stratified into the mild CCM cohort (mean age, 58.5 years; 62.8% male). Among them, 25 (58.1 %) patients were assigned to the improvement group and 18 (41.9 %) were assigned to the nonimprovement group. The improvement group was significantly younger than the nonimprovement group; however, other variables did not significantly differ. ROC curve analysis showed that the optimal cutoff point of the patient's age to discriminate between the improvement and nonimprovement groups was 58 years with an area under the curve of 0.702 (p=.015). CONCLUSIONS: In the present study, the majority of patients with mild CCM experienced improvement reaching the MCID of JOA score at 1 year postoperatively. The present study suggests that for younger patients with mild CCM, especially those aged below 58 years, subjective neurological recovery is more likely to be obtained. Meanwhile, the surgery takes on a more prophylactic significance to halt disease progression for older patients. The results of this study can help in the decision-making process for this clinical population. CI - Copyright (c) 2023 Elsevier Inc. All rights reserved. FAU - Hirai, Hiromichi AU - Hirai H AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Fujishiro, Takashi AU - Fujishiro T AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan; Department of Orthopedic Surgery, First Towakai Hospital, 2-17, Miyano-machi, Takatsuki, Osaka 569-0081, Japan. Electronic address: takashi.fujishiro@ompu.ac.jp. FAU - Nakaya, Yoshiharu AU - Nakaya Y AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Hayama, Sachio AU - Hayama S AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Usami, Yoshitada AU - Usami Y AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Mizutani, Masahiro AU - Mizutani M AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Nakano, Atsushi AU - Nakano A AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. FAU - Neo, Masashi AU - Neo M AD - Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigakumachi, Takatsuki, Takatsuki 569-8686, Japan. LA - eng PT - Journal Article DEP - 20230901 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Aged MH - Humans MH - Male MH - Middle Aged MH - Female MH - *Spinal Cord Compression/etiology/surgery MH - Retrospective Studies MH - Treatment Outcome MH - *Spinal Cord Diseases/surgery MH - Cervical Vertebrae/surgery MH - *Ossification of Posterior Longitudinal Ligament/surgery MH - *Spondylosis/surgery MH - *Laminoplasty/methods OTO - NOTNLM OT - Cervical compressive myelopathy OT - Cervical laminoplasty OT - Cervical spondylotic myelopathy OT - JOA score OT - Japanese Orthopedic Association score OT - Mild myelopathy OT - Minimum clinically important difference OT - Ossification of the posterior longitudinal ligament COIS- Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2023/09/04 00:41 MHDA- 2023/12/18 06:42 CRDT- 2023/09/03 19:27 PHST- 2023/04/26 00:00 [received] PHST- 2023/07/31 00:00 [revised] PHST- 2023/08/29 00:00 [accepted] PHST- 2023/12/18 06:42 [medline] PHST- 2023/09/04 00:41 [pubmed] PHST- 2023/09/03 19:27 [entrez] AID - S1529-9430(23)03364-8 [pii] AID - 10.1016/j.spinee.2023.08.013 [doi] PST - ppublish SO - Spine J. 2024 Jan;24(1):68-77. doi: 10.1016/j.spinee.2023.08.013. Epub 2023 Sep 1.