Prediction of outcome following laminoplasty of cervical spondylotic myelopathy: Focus on the minimum clinically important difference.
The minimum clinically important difference (MCID) of the Japanese Orthopaedic Association (JOA) score has been reported to be around 2.5 points in cervical myelopathy. This study sought to define significant predictive factors on achieving the MCID following laminoplasty in a large series of patients with cervical spondylotic myelopathy (CSM). A total of 485 consecutive patients with CSM (295 males and 190 females; mean age: 67.0 years; age range: 42-91 years) who underwent laminoplasty were prospectively enrolled. The average postoperative follow-up period was 26.6 months (range: 12-66 months). We calculated the achieved JOA score. The relationships between outcomes and various clinical and imaging predictors including comorbidity and quantitative performance tests were examined. Logistic regression analysis was conducted to identify the predictors correlated with a JOA score of 2.5 points or more. Clinically meaningful gains were exhibited in 299 patients (61.6%) with a JOA score of ≥2.5 points, whereas 186 patients (38.4%) achieved a JOA score of <2.5 points. Univariate logistic regression analysis showed the predictive factors with a shorter duration of CSM symptoms, lower preoperative JOA scores, absence of hypertension, no use of anticoagulant/antiplatelet agents, and nonsmoking status. Multivariate logistic regression analysis determined that the duration of CSM symptoms (odds ratio: 0.771, 95% confidence interval: 0.705-0.844; p < 0.01) was the only significant predictive factor for achieving JOA scores of ≥2.5 points. An important predictor of MCID achievement following laminoplasty was shorter duration of CSM symptoms.
['Machino|Masaaki|M|', 'Ando|Kei|K|', 'Kobayashi|Kazuyoshi|K|', 'Nakashima|Hiroaki|H|', 'Kanbara|Shunsuke|S|', 'Ito|Sadayuki|S|', 'Inoue|Taro|T|', 'Koshimizu|Hiroyuki|H|', 'Ito|Keigo|K|', 'Kato|Fumihiko|F|', 'Imagama|Shiro|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002574:Cervical Vertebrae D005260:Female D006801:Humans D065406:Laminoplasty D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D011446:Prospective Studies D020127:Recovery of Function D012307:Risk Factors D013118:Spinal Cord Diseases D055009:Spondylosis D013997:Time Factors D016896:Treatment Outcome
Prediction Outcome Laminoplasty Cervical spondylotic myelopathy Minimum clinically important difference Multivariate analysis