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Impact of Preoperative Inability to Walk on Surgical Outcomes in Degenerative Cervical Myelopathy: A Prospective
Toshiki Okubo1,2, Narihito Nagoshi1,2, Junichi Yamane2,3
1Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Study Design:
Prospective multicenter cohort study.
Objectives:
To assess the impact of preoperative inability to walk on surgical outcomes in degenerative cervical myelopathy (DCM) and to identify factors linked to persistent inability to walk.
Summary Of Background Data:
Inability to walk signifies advanced neurological impairment in DCM and is associated with functional disability. However, its effects on postoperative recovery and prognostic factors remain unclear.
Methods:
A total of 935 patients with DCM from ten spine centers were analyzed. Preoperative inability to walk was defined as a Japanese Orthopaedic Association (JOA) lower extremity score ≤1. Patients were classified into two groups: those who could walk (n=706) and those who could not walk (n=229). Among those unable to walk preoperatively, outcomes at 2 years were categorized as improved or persistent. Clinical outcomes included the JOA score, visual analog scale, JOACMEQ, SF-36, and NPSI. General linear models were used for adjusted comparisons, and logistic regression was used to identify factors associated with persistent inability to walk.
Results:
Patients unable to walk preoperatively had worse baseline status but showed greater absolute improvement in the JOA scores than those able to walk (ΔJOA, 4.3 vs. 2.5, P <0.001). The JOA score recovery rates were similar across the groups. Among patients with preoperative inability to walk, 72.1% regained the ability to walk, whereas 27.9% remained unable to walk at 2 years. Cardiac disease (OR, 2.949), cerebrovascular disease (OR, 5.373), and longer symptom duration (OR, 1.015) were independently associated with a persistent inability to walk. Improvements in mental health and neuropathic pain were not associated with walking recovery.
Conclusions:
Most patients with DCM who were unable to walk preoperatively regained their walking ability after surgery. However, vascular comorbidities and longer symptom durations were associated with a persistent inability to walk, which may inform surgical timing and patient counseling.
Level Of Evidence:
II.