Purpose: This study investigated functionality statues and surgical outcome of patients with cervical spondylotic myelopathy (CSM) contains cervical herniated disc (CHD) and cervical spinal stenosis (CSS) based on the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).Methods: This was a prospective clinical study a sample of cases with CSM. Patient’s functionality statues and surgical outcome were evaluated based on JOACMEQ scores at two points in time: pre- and postoperative assessments.Results: In all 87 patients were completed the JOACMEQ measure. The mean age of patients was 50.3 (SD=10.2) years. The mean clinical follow-up was 12 months (range 7-37 months). Statistically difference between was observed pre- and postoperative indicating improvements on the outcomes and functionality in all subscales (P &lt; 0.001). However, there was no significant difference between patients with CSM and CHD.Conclusion: The findings suggest that surgery is an efficacious procedure for the treatment of CSM and the functionality statues as measured by the JOACMEQ are higher than prior to surgery

Alizadeh, Pooyan

Azimi, Parisa

Mohammadi, Hassan Reza

Shahzadi, Andia

Shahzadi, Sohrab

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48Original ArticleInternational Clinical Neuroscience Journal  •  Vol 1, No 2, Autumn 2014Surgery outcomes and functionality in patients with cervical spondylotic myelopathyParisa Azimi1, Sohrab Shahzadi1, Hassan Reza Mohammadi1, Pooyan Alizadeh1, Andia Shahzadi21 Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran2 University of Toronto, Ontario, CanadaABSTRACTPurpose: This study investigated functionality statues and surgical outcome of patients with cervical spondylotic myelopathy (CSM) contains cervical herniated disc (CHD) and cervical spinal stenosis (CSS) based on the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).Methods: This was a prospective clinical study a sample of cases with CSM. Patient’s functionality statues and surgical outcome were evaluated based on JOACMEQ scores at two points in time: pre- and postoperative assessments.Results: In all 87 patients were completed the JOACMEQ measure. The mean age of patients was 50.3 (SD=10.2) years. The mean clinical follow-up was 12 months (range 7-37 months). Statistically difference between was observed pre- and postoperative indicating improvements on the outcomes and functionality in all subscales (P < 0.001). However, there was no significant difference between patients with CSM and CHD.Conclusion: The findings suggest that surgery is an efficacious procedure for the treatment of CSM and the functionality statues as measured by the JOACMEQ are higher than prior to surgery.Keywords: JOACMEQ; Surgery outcomes and functionality; Cervical spondylotic myelopathyINTRODUCTIONCervical spondylotic myelopathy (CSM) contains cervical herniated disc (CHD) and cervical spinal stenosis (CSS) is the most common degenerative disease. It is usually a chronic and progressive disease. The prevalence of patients with CSM increases as they grow older1. Thus, assessment of treatment outcome and functionality in those who suffer from the disease is an important part of clinical practice. As such the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a well-known instrument to assess outcome and functionality in this population2. The JOACMEQ) has been validated as an outcome measure in this patient2.Thus, the aim of this study was to evaluate surgery outcomes and functionality in patients with CSM diseases based on JOACMEQ.MATERIAL AND METHODSPatients and data collectionThis was a cross sectional study and included consecutive patients who were referred to a convenient sample of newly diagnosed CSM patients attending the neurosurgery clinic of a large teaching hospital in Tehran, Iran during May 2008 to November 2011. The diagnosis of CSM was made based on clinical symptoms, ICNSJ 2014; 1 (2):48-50 www.journals.sbmu.ac.ir/neuroscienceCorrespondence to: Parisa Azimi, MD; Shohada Tajrish Hospital, Functional Neurosurgery Research Center of Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; E-mail: parisa.azimi@gmail.com; Tel: +98(21)22749204; Fax: +98(21)88265188Received: October 2, 2014 Accepted: October 16, 2014Surgery in cervical spondylotic myelopathy—Azimi et al49International Clinical Neuroscience Journal  •  Vol 1, No 2, Autumn 2014neurological examinations, and imaging including plain radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the cervical and spine. All patients had the typical symptoms of CSM. The stenotic level(s) were localized on the MRI or CT images. There were no restrictions on patient selection with regard to types of CSM, age or other characteristics. The exclusion criteria were prior cervical spine surgery and spinal anomalies. Patients were assessed at two points in time: pre-operative and post-operative based on JOACMEQ. Standard surgery technique was used. Patients were undertaken laminectomy with or without fusion procedure for CSS and posterior discectomy approach for CHD3.The JOACMEQ scoreThe Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) is a revised version of the Japanese Orthopedic Association score (JOA). It was developed for the purpose of evaluating cervical myelopathy disorders2. It is a tool and contains 24 items tapping into five subscales: lower extremity function (5 items), quality of life (8 items), cervical spine function (4 items), bladder function (4 items), and upper extremity function (5 items). The score for each subscale ranges from 0 to 100 and higher scores indicate better conditions2. Pre- and post-operative scores was compared using the paired t-test in order to assess of surgical outcomes and functionality based on JOACMEQ.Statistical analysisAll statistical analyses were performed using the PASW Statistics 18 Version 18 (SPSS, Inc., 2009, Chicago, IL, USA). The t-test was used for comparison. P value lea than 0.05 was considered statistically significant.EthicsThe Ethics Committee of Shahid Beheshti University of Medical Sciences approved the study.RESULTSIn all 96 patients were approached. Of these 87 patients completed the questionnaire and nine patients were excluded due to prior cervical spine surgery or spinal anomalies. The characteristics of the CSM patients and their scores on the JOACMEQ are shown in Table 1. The mean age of patients was 50.3 (SD=10.2) years. The mean clinical follow-up was 12 months (range 7-37 months). Most patients with CSM had a developmental narrow spinal canal, and decompressive laminae were distributed from C2 to T1 levels. The number of decompressed lamina was 3.3 (SD=1.1). Meanwhile, most patients with CHD had a one- or two level discectomy and were distributed from C2 to C7 levels.Overall 90.8% of patients improved with surgery (n=9) and the remaining 9.1% of patients had no change in their JOACMEQ score after surgery (n=8). Statistically difference between was observed pre- and postoperative indicating improvements on the outcomes and functionality in all subscales (P<0.001).The results are shown in Table 2. However, there was no significant difference between patients with CSM and CHD. The most common complications were C5 nerve palsies which occurred in 5.7% of the cohort (n=5); all completely resolved. Re-operation was not required at final follow-up.DISCUSSIONThe findings from this study suggest that a statistically significant difference exists between pre- and postoperative functionality statues in patients with CSM based on JOACMEQ score.In many previous studies, surgical outcomes of patients with CSM were evaluated based on variety of measures and good results have been reported. Meanwhile, all authors identified that cervical decompression has enough effectiveness for the patients with CSM4, which is in line our findings. However, to our knowledge, the present study is first report about assessment of functionality Number* (%)Age groups (Year) 50.3 (10.2%)Range 24-79GenderMale 39 (44.8%)Female 48 (55.2%)Type of diseaseCervical herniated disc 50 (57.5%)Cervical spinal stenosis 37 (42.5%)*Values are mean (SD) or number and percent.Table 1. The characteristics of the study sample (n =87).PreoperativeMean (SD)PostoperativeMean (SD) P value*Lower extremity function41.3 (24.3) 69.7 (11.2) < 0.001Quality of life 32.4 (25.6) 56.1 (7.6) < 0.001Cervical spine function 51.1 (29.3) 76.9 (9.3) < 0.001Bladder function 61.3 (19.3) 79.3 (7.3) < 0.001Upper extremity function48.4 (15.4) 59.1 (12.4) < 0.001*Derived from paired samples t-testTable 2. Responsiveness to change as measured by the JOACMEQ.Surgery in cervical spondylotic myelopathy—Azimi et al50 International Clinical Neuroscience Journal  •  Vol 1, No 2, Autumn 2014statues and surgical outcome of patients with CHD and CSS according to JOACMEQ in literature.The JOACMEQ simultaneously considers a five subscale as lower extremity function, quality of life, cervical spine function, bladder function and upper extremity function in cases with CSM, so this measure may be more useful for assess these patients. There is a variety of measurements in the literature for patients with CSM. However, the JOACMEQ offers an effective method of evaluation of quality of life5, and as suggested it is possible that the JOACMEQ will succeed and become a global standard to evaluate outcomes in patients with cervical myelopathy6.The limitations of this study were: first, we cannot outcomes analysis based on type of disease. second, we set up 12 months (range 7-37 months) follow up as the point of times for evaluating clinical outcomes. However, these data are just short-term follow up data, so there is a possibility that these data don’t reflect on the natural course of postoperative functionality. Then, it is essential that long-term follow up analysis should be reinforced for further work-up.CONCLUSIONThe findings suggest that surgery is an efficacious procedure for the treatment of CSM and the functionality statues as measured by the JOACMEQ are higher than prior to surgery.ACKNOWLEDGMENTThe authors thank the staff of the Neurosurgery Unit at Imam-Hossain Hospital, Tehran, Iran.FINANCIAL DISCLOSURENone to declareREFERENCES1. Traynelis VC, Arnold PM, Fourney DR, Bransford RJ, Fischer DJ, Skelly AC. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety. Spine. 2013;38(22 Suppl 1):S210-31.2. Azimi P, Rezaei O, Montazeri A. An outcome measure of functionality and quality of life in patients with cervical myelopathy. Iran Red Crescent Med J. 2014;16(6):e8102.3. Winn HR. Youmans Neurological Surgery. Degenerative Disease of the Spine. 6th ed. Philadelphia, PA, WB Saunders Company; 2004:2859-2935.4. Son DK, Son DW, Song GS, Lee SW. Effectiveness of the laminoplasty in the elderly patients with cervical spondylotic myelopathy. Korean J Spine. 2014;11(2):39-44.5. Nikaido T, Kikuchi S, Yabuki S, Otani K, Konno S. Surgical treatment assessment using the Japanese orthopedic association cervical myelopathy evaluation questionnaire in patients with cervical myelopathy: a new outcome measure for cervical myelopathy. Spine. 2009;34(1):2568-72.6. Fukui M, Chiba K, Kawakami M, Kikuchi S, Konnno S, Miyamoto M, et al. Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ): part 2. Endorsement of the alternative item. J Orthop Sci. 2007;12(3): 241-8.

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Surgery outcomes and functionality in patients with cervical spondylotic myelopathy

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