Time course of symptomatic improvement after open-door laminoplasty for cervical spondylotic myelopathy

Cervical spondylotic myelopathy (CSM) is a progressive degenerative disease that is one of the most common neurological disorders in the elderly, and causes cervical spinal cord dysfunction. Upper and lower extremity sensory disturbances, hand clumsiness, gait disturbance, and urinary dysfunction are common symptoms of CSM. Laminoplasty is one of the standard treatments to decompress the spinal cord and treat CSM, and the long-term results of this procedure are excellent [[1], [2], [3], [4], [5]]. However, there are few reports in the existing literature that have investigated the length of time over which the preoperative symptoms of CSM patients improve after surgery using patient-reported outcome measures [6,7]. This is partly because there are few longitudinal studies published that have used the same assessment methods before and after surgery.

There are various scoring systems that are used in the clinical evaluation of CSM. The Japanese Orthopaedic Association (JOA) scoring system, as well as the modified JOA scoring system (mJOA), is one of the most commonly used [8]. However, the JOA scoring system has the disadvantage that it is a subjective evaluation by the physician, and it can be difficult to accurately assess a patient's complaints. With the increasing popularity of evidence-based medicine (EBM), evaluation methods are required to be ‘universal’, ‘logical’, and ‘objective’. Furthermore, as Macnab et al. have proposed [9], it is also important to introduce the patient's point of view into the evaluation process, and not just rely on the perspective of the medical professional. In light of this, the Japanese Orthopaedic Association has developed the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) [10]. As a patient-reported outcome measure, the JOACMEQ requires patients to answer 24 questions themselves across five domains: cervical spine function, upper extremity function, lower extremity function, bladder function, and quality of life (QOL). The reliability, reproducibility, and validity of this assessment method have already been examined and proven, and the mean values according to age and gender in healthy subjects have also been reported [11].

With this in mind, the aim of this study was to investigate in a prospective and multidimensional manner the time course of symptomatic improvement after surgery in patients with CSM undergoing laminoplasty, as well as the factors that affect the outcome of surgery, using a patient-reported outcome measure.

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