A Retrospective Study of Degenerative Cervical Myelopathy and the Surgical Management Within Northern Ireland

Cureus, 2023 · DOI: 10.7759/cureus.49513 · Published: November 27, 2023

Simple Explanation

Degenerative cervical myelopathy (DCM) involves age-associated pathological changes of the cervical spine that can result in spinal cord compression. This compression can lead to motor and sensory function deficits, balance and dexterity issues, and bladder and bowel disturbances. This retrospective study evaluated the surgical management of DCM in Northern Ireland, aiming to understand surgical management patterns and patient outcomes. The study analyzed specific scoring systems at different time points to highlight the efficacy and potential improvement areas in DCM management. The study found that mJOA scores tend to improve after surgery, especially at six months. Anterior approach surgery is linked to fewer complications and shorter hospital stays, while pre-surgery mJOA scores and post-surgery complications predict the length of hospital stay.

Study Duration

Three years with one-year follow-up

Participants

102 patients (10:7, male:female) with DCM

Evidence Level

Retrospective study

Key Findings

1
The mJOA score tends to improve after surgery for the majority of patients, particularly at six months, which is consistent with the literature.
2
Anterior approach surgery is associated with a lower rate of complications and shorter post-surgery length of stay in hospital compared to posterior approach surgery.
3
The pre-surgery mJOA score and the presence of complications post surgery significantly predict the post-surgery length of stay.

Research Summary

This retrospective study evaluated the surgical management of degenerative cervical myelopathy (DCM) in Northern Ireland over three years, with a one-year follow-up, using data from the Fracture Outcome Research Database. It included 102 patients and assessed variables like gender, age, symptoms, surgery type, complications, and mJOA scores. The study found that mJOA scores improved significantly post-surgery, especially at six months. Anterior approach surgery was associated with fewer complications and shorter hospital stays, while posterior approach surgery had a higher complication rate. Pre-surgery mJOA scores and post-surgery complications significantly predicted the length of hospital stay. The study highlights the effectiveness of surgical management for DCM and suggests areas for improving patient care and surgical planning.

Practical Implications

Improved Patient Outcomes

Surgical intervention, particularly anterior approach, can significantly improve motor function and sensation in DCM patients, enhancing their quality of life.

Optimized Surgical Planning

Considering pre-surgery mJOA scores and potential complications can help healthcare providers better plan post-surgery care and resource allocation.

Reduced Hospital Stays

Prioritizing anterior approach surgery when appropriate can lead to shorter hospital stays and lower complication rates, benefiting both patients and healthcare systems.

Study Limitations

1
Retrospective nature of the study may introduce information bias.
2
Comorbidities may have affected mJOA assessment and score.
3
Specific mechanism of cord compression was not explored, and patient-reported outcomes were not included.

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