A service evaluation of inpatient perioperative rehabilitation provision in degenerative cervical myelopathy

Degenerative cervical myelopathy (DCM) is a condition of symptomatic cervical spinal cord dysfunction secondary to degenerative changes causing mechanical compression. Neurorehabilitation refers to an integrated, multidisciplinary care programme that aims to optimise function following a nervous system disorder. Neurorehabilitation is standard of care following many neurological conditions. However, this is not widely the case for patients with DCM. This work aimed to characterise current inpatient perioperative rehabilitation provision for patients with DCM who underwent surgical management at a single tertiary centre.

In this retrospective service evaluation, routine data were collected from electronic healthcare records for patients who had undergone surgery for DCM in a single tertiary neurosciences centre since 2014 (n = 593). Data were analysed for patient demographics, operative management, complications, and evidence of perioperative inpatient rehabilitation. Outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) score.

Mean patient age was 62.7 years at surgery; 58.8 % (349/593) were male. The most common surgery was an anterior cervical discectomy and fusion (62 %, 349/593); overall complication rate was 6.1 % (36/593). Mean hospital stay was 5.6 ± 10.3 days; modal stay was one day. Sixty-seven percent (398/593) of patients received perioperative rehabilitation with a mean of 4.8 sessions per patient. Physiotherapy (64 %, 380/593; mean 2.4 sessions) and occupational therapy (27 %, 160/593; mean 1.2 sessions) were the most common forms of rehabilitation. The average wait for therapy to start was 1.4 days. A total of 30 % (178/593) of patients had an mJOA assessment preoperatively: 99 patients had severe DCM, 59 moderate DCM, and 20 mild DCM. Mean preoperative mJOA score was 11.20; mean post-operative mJOA score at one year was 12.95 (p < 0.01). There was no statistically significant difference in change in mJOA score for patients who received perioperative rehabilitation and those who did not (p = 0.32). A greater proportion of patients with severe DCM received physiotherapy (82 %, 81/99) compared to those with moderate (73 %, 43/59) and mild DCM (55 %, 11/20) (p = 0.03).

Neurorehabilitation has been predicted to optimise functional recovery following decompressive surgery for DCM, however its exact role and what it should constitute remains undefined. This service evaluation has highlighted the need to improve understanding of the provision of perioperative rehabilitation and use scoring systems to quantitatively determine outcomes. Future studies should prospectively investigate the efficacy of DCM rehabilitation.