Li Michael K, Guru Santosh, Vellaiyappan Sundar, Mathew Alan, Rafati Fard Amir, Smith Toby O, Mee Harry, Anwar Fahim, Kotter Mark R N, Davies Benjamin M, Mowforth Oliver D
Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Warwick Medical School, University of Warwick, Coventry, UK.
J Clin Neurosci. 2025 Aug 1;140:111518. doi: 10.1016/j.jocn.2025.111518.
Degenerative cervical myelopathy (DCM) is a condition of symptomatic cervical spinal cord dysfunction secondary to degenerative changes causing mechanical compression. Neurorehabilitation refers to an integrated, multidisciplinary care programme that aims to optimise function following a nervous system disorder. Neurorehabilitation is standard of care following many neurological conditions. However, this is not widely the case for patients with DCM. This work aimed to characterise current inpatient perioperative rehabilitation provision for patients with DCM who underwent surgical management at a single tertiary centre.
In this retrospective service evaluation, routine data were collected from electronic healthcare records for patients who had undergone surgery for DCM in a single tertiary neurosciences centre since 2014 (n = 593). Data were analysed for patient demographics, operative management, complications, and evidence of perioperative inpatient rehabilitation. Outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) score.
Mean patient age was 62.7 years at surgery; 58.8 % (349/593) were male. The most common surgery was an anterior cervical discectomy and fusion (62 %, 349/593); overall complication rate was 6.1 % (36/593). Mean hospital stay was 5.6 ± 10.3 days; modal stay was one day. Sixty-seven percent (398/593) of patients received perioperative rehabilitation with a mean of 4.8 sessions per patient. Physiotherapy (64 %, 380/593; mean 2.4 sessions) and occupational therapy (27 %, 160/593; mean 1.2 sessions) were the most common forms of rehabilitation. The average wait for therapy to start was 1.4 days. A total of 30 % (178/593) of patients had an mJOA assessment preoperatively: 99 patients had severe DCM, 59 moderate DCM, and 20 mild DCM. Mean preoperative mJOA score was 11.20; mean post-operative mJOA score at one year was 12.95 (p < 0.01). There was no statistically significant difference in change in mJOA score for patients who received perioperative rehabilitation and those who did not (p = 0.32). A greater proportion of patients with severe DCM received physiotherapy (82 %, 81/99) compared to those with moderate (73 %, 43/59) and mild DCM (55 %, 11/20) (p = 0.03).
Neurorehabilitation has been predicted to optimise functional recovery following decompressive surgery for DCM, however its exact role and what it should constitute remains undefined. This service evaluation has highlighted the need to improve understanding of the provision of perioperative rehabilitation and use scoring systems to quantitatively determine outcomes. Future studies should prospectively investigate the efficacy of DCM rehabilitation.
退行性颈椎脊髓病（DCM）是一种由于退行性变导致机械性压迫而引起症状性颈脊髓功能障碍的疾病。神经康复是指一个综合的、多学科的护理计划，旨在优化神经系统疾病后的功能。神经康复是许多神经系统疾病后的标准护理。然而，对于DCM患者来说，情况并非如此。这项研究旨在描述在一个单一的三级中心接受手术治疗的DCM患者当前的围手术期住院康复情况。
在这项回顾性服务评估中，收集了自2014年以来在一个单一的三级神经科学中心接受DCM手术患者的电子医疗记录中的常规数据（n = 593）。分析了患者的人口统计学、手术管理、并发症以及围手术期住院康复的证据。使用改良日本骨科协会（mJOA）评分评估结果。
手术时患者的平均年龄为62.7岁；58.8%（349/593）为男性。最常见的手术是颈椎前路椎间盘切除融合术（62%，349/593）；总体并发症发生率为6.1%（36/593）。平均住院时间为5.6±10.3天；住院天数的众数为1天。67%（398/593）的患者接受了围手术期康复，平均每位患者接受4.8次治疗。物理治疗（64%，380/593；平均2.4次）和职业治疗（27%，160/593；平均1.2次）是最常见的康复形式。治疗开始的平均等待时间为1.4天。共有30%（178/593）的患者术前进行了mJOA评估：99例患者患有严重DCM，59例为中度DCM，20例为轻度DCM。术前平均mJOA评分为11.20；术后一年的平均mJOA评分为12.95（p < 0.01）。接受围手术期康复和未接受围手术期康复的患者在mJOA评分变化上没有统计学显著差异（p = 0.32）。与中度（73%，43/59）和轻度DCM（55%，11/20）患者相比，严重DCM患者接受物理治疗的比例更高（82%，81/99）（p = 0.03）。
神经康复被认为可以优化DCM减压手术后的功能恢复，但其确切作用和应包含的内容仍不明确。这项服务评估强调了需要更好地理解围手术期康复的提供情况，并使用评分系统来定量确定结果。未来的研究应前瞻性地研究DCM康复的疗效。
