Abstract
Purpose
To find the cut-off values in the Myelopathy Disability Index (MDI) that will allow us to classify the severity of Degenerative Cervical Myelopathy (DCM) into mild, moderate and severe.
Methods
Cross-sectional study with prospective data collection, with a total of 64 patients diagnosed with Degenerative Cervical Myelopathy (DCM). Anthropometric, diagnostic, neurological, functional and quality of life variables were collected. A Receiver Operating Curve (ROC) was performed. The cut-off points were validated by comparing the functional status of patients in the 3 groups and their Nurick scores.
Results
Sixty-four patients (23 women) with a mean age of 61.97 (SD 11.57) participated in this study. The majority of patients were Nurick I (28.13%) and Nurick II (32.81%). The medium MDI was 7.36 (SD 6.66) and the mJOA was 14.08 (SD 2.57). The mild-moderate cut-off value was between 4 and 5, with an Area Under the Curve (AUC) of 0.805, sensitivity of 0.853 and specificity of 0.6. For moderate-severe, the cut-off value obtained was between 7 and 8, with an AUC of 0.862, sensitivity of 0.857 and specificity of 0.684. Patients with greater severity had significantly lower functionality, with a P-value of 0.004 in the 30 Metre Walking Test and 0.005 in the Nine-Hole Peg Test. Established severity groups were also significantly related to the different categories of the Nurick score (P-value = 0.000).
Conclusion
MDI values between 0 and 4 correspond to mild DCM, between 5 and 7 would be moderate DCM and from 8 to 30 indicate severe DCM.
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References
Bartels, Ronald HMA (2021) A new dimension in degenerative cervical myelopathy. The Lancet Neurol.20(2): 82–83. doi: https://doi.org/10.1016/S1474-4422(20)30454-3
Nouri A, Tetreault L, Singh A, Karadimas SK, Fehlings MG (2015) Degenerative cervical myelopathy: epidemiology, genetics, and pathogenesis. Spine 40(12):E675–E693. https://doi.org/10.1097/BRS.0000000000000913
Fehlings M, Singh A, Tetreault L, Kalsi-Ryan S, Nouri A (2014) Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol 309:8. https://doi.org/10.2147/CLEP.S68889
Tetreault LA, Skelly AC, Dettori JR, Wilson JR, Martin AR, Fehlings MG (2017) Guidelines for the management of degenerative cervical myelopathy and acute spinal cord injury: development process and methodology. Glob Spine J. https://doi.org/10.1177/2192568217701715
Badhiwala JH, Witiw CD, Nassiri F, Akbar MA, Mansouri A, Wilson JR, Fehlings MG (2019) Efficacy and safety of surgery for mild degenerative cervical myelopathy: results of the AOSpine North America and international prospective multicenter studies. Neurosurgery 84(4):890–897. https://doi.org/10.1093/neuros/nyy133
Davies BM, McHugh M, Elgheriani A, Kolias AG, Tetreault LA, Hutchinson PJA, Fehlings MG, Kotter MRN (2016) Reported outcome measures in degenerative cervical myelopathy: a systematic review. Edited by Faiz Ahmad. PLOS ONE. 11(8):e0157263. https://doi.org/10.1371/journal.pone.0157263
Yonenobu K, Abumi K, Nagata K, Taketomi E, Ueyama K (2001) Interobserver and intraobserver reliability of the japanese orthopaedic association scoring system for evaluation of cervical compression myelopathy. Spine 26(17):1890–1894. https://doi.org/10.1097/00007632-200109010-00014
Kato So, Oshima Y, Oka H, Chikuda H, Takeshita Y, Miyoshi K, Kawamura N et al (2015) Comparison of the Japanese Orthopaedic Association (JOA) score and modified JOA (MJOA) score for the assessment of cervical myelopathy: a multicenter observational study. Edited by Michael Fehlings PLOS ONE 10(4):e0123022. https://doi.org/10.1371/journal.pone.0123022
Martin AR, Jentzsch T, Wilson JRF, Moghaddamjou A, Jiang F, Rienmueller A, Badhiwala JH et al (2021) Inter-rater reliability of the modified japanese orthopedic association score in degenerative cervical myelopathy: a cross-sectional study. Spine 46(16):1063–1069. https://doi.org/10.1097/BRS.0000000000003956
Casey AT, Bland JM, Crockard HA (1996) Development of a functional scoring system for rheumatoid arthritis patients with cervical myelopathy. Ann Rheum Dis 55(12):901–906. https://doi.org/10.1136/ard.55.12.901
Kalsi-Ryan S, Singh A, Massicotte EM, Arnold PM, Brodke DS, Norvell DC, Hermsmeyer JT, Fehlings MG (2013) Ancillary outcome measures for assessment of individuals with cervical spondylotic myelopathy. Spine 38:S111–S122. https://doi.org/10.1097/BRS.0b013e3182a7f499
Singh A, Crockard HA (2001) Comparison of seven different scales used to quantify severity of cervical spondylotic myelopathy and post-operative improvement. J Outcome Meas 5(1):798–818
Tetreault L, Kopjar NA et al (2017) The modified japanese orthopaedic association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J 26(1):78–84. https://doi.org/10.1007/s00586-016-4660-8
Davies BM, Nourallah B, Venkatesh A, Ali AMS, Guilfoyle M, Francis J, Kotter MRN, Laing RJC (2020) Establishing mild, moderate and severe criteria for the myelopathy disability index in cervical spondylotic myelopathy. Br J Neurosurg. https://doi.org/10.1080/02688697.2020.1839741
Vernon H, Mior S (1991) The neck disability index: a study of reliability and validity. J Manipulative Physiol Ther 14(7):409–415
Kopjar B, Tetreault L, Kalsi-Ryan S, Fehlings M (2015) Psychometric properties of the modified japanese orthopaedic association scale in patients with cervical spondylotic myelopathy. Spine 40(1):E23-28. https://doi.org/10.1097/BRS.0000000000000648
Tetreault L, Nouri A, Kopjar B, Cote P, Fehlings MG (2015) The minimum clinically important difference of the modified Japanese orthopaedic association scale in patients with degenerative cervical myelopathy. Spine 40(21):1653–1659
Hilton B, Tempest-Mitchell J, Davies B, Kotter M (2018) Assessment of degenerative cervical myelopathy differs between specialists and may influence time to diagnosis and clinical outcomes. PLoS ONE 13(12):e0207709
Behrbalk E, Salame K, Regev GJ, Keynan O, Boszczyk B, Lidar Z (2013) Delayed diagnosis of cervical spondylotic myelopathy by primary care physicians. Neurosurg Focus 35(1):E1. https://doi.org/10.3171/2013.3.FOCUS1374
Tetreault L, Garwood Ph, Gharooni AA et al. (2022) Improving assessment of disease severity and strategies for monitoring progression in degenerative cervical myelopathy [AO Spine RECODE-DCM Research Priority Number 4] Global Spine J 12 (1S)64S-77S
Acknowledgements
The author thanks MBA Institute without whose collaboration it has not been possible to carry out this work. This work has been presented at the annual congress of the Spanish Society of Spinal Surgery (GEER)
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Pons Carreto, A., Ramírez Valencia, M., de García Frutos, A. et al. Myelopathy disability index: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy. Eur Spine J 32, 584–589 (2023). https://doi.org/10.1007/s00586-022-07506-2
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DOI: https://doi.org/10.1007/s00586-022-07506-2