Clinical Indicators of Surgical Outcomes in Degenerative Cervical Myelopathy Assessed Using the JOACMEQ: A Prospective Multicenter Study

Abstract

Study design: A prospective multicenter cohort study.

Objective: To identify clinical indicators associated with postoperative functional and quality-of-life (QOL) outcomes in patients with degenerative cervical myelopathy (DCM), using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).

Summary of background data: Although surgical intervention is the standard treatment for DCM, a subset of patients experience suboptimal postoperative outcomes. The specific impact of surgical treatment on various physical functions in patients with DCM remains inadequately understood.

Materials and methods: A total of 935 DCM patients were prospectively enrolled and were followed up for 2 years across 10 institutions in Japan. Of these, 852 patients with complete JOACMEQ data were included. Preoperative and postoperative assessments at 2 years included JOA score, visual analog scale, and JOACMEQ. Logistic regression analyses were conducted to identify indicators of effective outcomes across JOACMEQ domains.

Results: Surgical intervention led to significant improvements in JOA scores and pain reduction. Effective rates by the JOACMEQ domain were 49.6% (cervical function), 48.5% (upper extremity), 35.1% (lower extremity), 23.2% (bladder), and 23.8% (QOL). Multivariate analysis revealed that better cervical function was associated with lower body mass index (BMI) and reduced neck pain at 2 years. Shorter symptom duration and upper limb pain improvement predicted better upper extremity outcomes. Younger age, shorter symptom duration, and reduced lower limb pain were linked to improved lower extremity function. Bladder function was negatively affected by longer symptom duration. Lower QOL was associated with longer symptom duration, cardiovascular comorbidities, and persistent neck and upper limb pain at final follow-up.

Conclusion: Surgical intervention for DCM generally improves neurological function and pain. However, JOACMEQ analysis reveals that factors such as disease duration, residual pain, age, and BMI significantly influence physical function and QOL. These findings highlight the importance of surgical timing and adequate informed consent to optimize outcomes in DCM patients.

Keywords: JOACMEQ; age; body mass index; cervical spondylotic myelopathy; comorbidities; degenerative cervical myelopathy; ossification of the posterior longitudinal ligament; pain; patient-reported outcome; symptom duration.