Association between perioperative patient-reported outcomes and upper extremity functional performance in degenerative cervical myelopathy.

BACKGROUND

Degenerative cervical myelopathy (DCM) is caused by chronic compression of the cervical spinal cord. Individuals usually present with a combination of upper extremity dysfunction, imbalance, and bladder dysfunction, which impact overall quality of life. Various questionnaires like mJOA, Nurick, NDI, and DCM-72 have been used for disease stratification. Our study aims to evaluate the clinical correlation between self-reported measures and objective upper extremity assessments and to derive the minimal clinically important difference (MCID) for individuals with DCM.

METHODS

A prospective two-center study of consecutive patients diagnosed with DCM was undertaken. A comprehensive assessment of upper extremity functioning including dexterity, sensation, and muscle strength, as well as self-reported questionnaires were completed preoperatively, and at 6- and 12-months postoperative follow-up. Statistical analyses were conducted to evaluate the progression of self-reported measures postoperatively and to evaluate correlations with upper extremity functional assessments. A p-value <.05 was deemed statistically significant.

RESULTS

A total of 99 patients with DCM and 34 controls were followed up over a period of 12 months. Significant differences were observed in mJOA overall scores and subscores, NDI, Nurick, and PROMIS-10 Physical scores. Various upper extremity functional measures significantly correlated with the self-reported outcome measures, highlighting the correlation between functional impairment and diminished quality of life. Using mJOA at 6-months follow-up as an anchor, DCM-72 MCID values of 1.44, 3.20, and 6.92 were approximated for mild, moderate and severe DCM, respectively.

CONCLUSIONS

Individuals with DCM experience significant postoperative improvements in self-reported outcomes, and upper extremity functioning strongly correlates with these gains. The DCM-72 MCID values offer clinically relevant thresholds for composite upper extremity functional recovery.