Surgery for degenerative cervical myelopathy: a nationwide registry-based observational study with patient-reported outcomes

BACKGROUND: Indications and optimal timing for surgical treatment of degenerative cervical myelopathy (DCM) remain unclear, and data from daily clinical practice are warranted.OBJECTIVE: To investigate clinical outcomes following decompressive surgery for DCM.METHODS: Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the neck disability index (NDI) 1 yr after surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale.RESULTS: We included 905 patients operated between January 2012 and June 2018. There were significant improvements in all patient-reported outcome measures (PROMs) including NDI (mean -10.0, 95% CI -11.5 to -8.4, P<.001), EMS (mean 1.0, 95% CI 0.8-1.1, P<.001), EQ-5D index score (mean 0.16, 95% CI 0.13-0.19, P<.001), EQ-5D visual analogue scale (mean 13.8, 95% CI 11.7-15.9, P<.001), headache NRS (mean -1.1, 95% CI -1.4 to -0.8, P<.001), neck pain NRS (mean-1.8, 95% CI-2.0 to-1.5, P<.001), and arm pain NRS (mean -1.7, 95% CI -1.9 to -1.4, P<.001). According to GPE scale assessments, 229/513 patients (44.6%) experienced "complete recovery" or felt "much better" at 1 yr. There were significant improvements in all PROMs for both mild and moderate-to-severe DCM. A total of 251 patients (27.7%) experienced adverse effects within 3 mo.CONCLUSION: Surgery for DCM is associated with significant and clinically meaningful improvement across a wide range of PROMs.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie