Degenerative cervical myelopathy: establishing severity thresholds for neuromotor dysfunction in the aging spine using the NIH Toolbox Assessment Scale

GeroScience, 2024 · DOI: https://doi.org/10.1007/s11357-023-00983-3 · Published: October 25, 2023

Simple Explanation

This study focuses on degenerative cervical myelopathy (DCM), a condition causing spinal cord issues due to age-related spine degeneration. It uses the NIH Toolbox Motor Battery (NIHTBm) to objectively measure the severity of DCM. The goal is to define specific NIHTBm cutoff values that accurately classify how severe the neuromotor dysfunction from DCM is. The researchers measured motor skills like dexterity, grip strength, balance, and gait speed in DCM patients and healthy individuals. They then used statistical analysis to find cutoff points on the NIHTBm scale that indicate mild, moderate, and severe levels of myelopathy. These cutoff points were compared with disability scores to ensure they accurately reflected the patients' functional abilities. The study found specific score ranges on the NIHTBm that can distinguish between mild and moderate-to-severe DCM. These findings can help doctors better understand the specific motor deficits in DCM patients, leading to more precise treatment strategies and a better understanding of the condition's heterogeneity.

Study Duration

March 2021 and April 2023

Participants

45 DCM patients and 37 age-matched healthy subjects

Evidence Level

Not specified

Key Findings

1
Specific NIHTBm cutoff values were identified for classifying DCM severity based on motor assessments.
2
The identified NIHTBm motor score cutoff points correlated negatively with the DCM neck disability index (NDI).
3
Balance and dexterity measures were shown to be independent indicators of DCM dysfunction.

Research Summary

This study used the NIH Toolbox Motor Battery (NIHTBm) as an objective measure to determine DCM severity by defining NIHTBm cutoff values that can accurately classify the severity of DCM neuromotor dysfunction. The study identified thresholds for mild and moderate-to-severe impairments in dexterity, grip strength, balance, and gait speed using ROC curve analysis. The NIHTBm cutoff values were validated by comparing them with the disability index scores (NDI), showing that patients with moderate-to-severe myelopathy had significantly higher disability index scores.

Practical Implications

Enhanced Clinical Precision

The use of NIHTB in DCM allows enhanced clinical precision, enabling clinicians to better pinpoint specific motor deficits in DCM.

Improved Understanding of DCM Heterogeneity

The utility of objective assessment, NIHTB, allows us to gain a better understanding of the heterogeneity of DCM, which will enhance treatment strategies.

Foundation for Future Research

This study serves as a foundation for future research to facilitate the discovery of innovative treatment strategies for DCM and other neurological conditions.

Study Limitations

1
Small sample size impacts the generalizability of the findings.
2
The subjective scale mJOA was used as the anchor to define mild and moderate-to-severe myelopathy.
3
Limited to motor dysfunction; the inclusion of sensory dysfunction could complicate the understanding of heterogeneity with multiple subtypes of DCM.

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