Domain-specific recovery process of cervical myelopathy after laminoplasty using Japanese orthopaedic association cervical myelopathy evaluation questionnaire: a prospective study.

PURPOSE

To determine the duration required to achieve an "effective" status on each domain of the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) for patients who underwent laminoplasty to treat cervical spondylotic myelopathy (CSM) and identify predictive factors influencing the domain-specific recovery of these patients.

METHODS

We prospectively recruited 84 patients with CSM who underwent laminoplasty at two institutions between 2018 and 2020. JOACMEQ scores were recorded preoperatively and at 1, 3, 6 months, and 1 and 2 years postoperatively. The cumulative incidence of achieving an "effective" status--defined as either a ≥ 20-point increase in the domain score or a post-treatment score > 90 for patients with baseline scores < 90--was analyzed using the Kaplan-Meier method. For each domain, we evaluated the association of preoperative risk factors with time to achieve an "effective" status of postoperative outcomes.

RESULTS

Eighty-two patients were examined (61 men and 21 women; mean age: 70 years). The median time to achieve 50% "effective" status varied significantly across JOACMEQ domains (p = 0.006). Bladder function (12 months) and quality of life (QOL) (not reached) improved more slowly than cervical, upper, and lower extremity function (3 months). The univariate analysis indicated a significant association between sex and QOL improvement (p = 0.040); however, this association was not significant in the multivariate analysis.

CONCLUSIONS

This is the first prospective study examining recovery based on the domain-specific "effective" criteria in patients who underwent laminoplasty for CSM. Bladder function and QOL required a longer time to achieve an "effective" status than other JOACMEQ domains. Male sex may be a potential risk factor for delayed QOL improvement. The findings may be useful for preoperative counseling of men with CSM.