Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment
Abstract Object To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. Methods A retrospective chart review of all adult patients who underwent surgical decompression for cerv...
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| Veröffentlicht in: | World neurosurgery 2017-09, Vol.105, p.314-320 |
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| creator | De la Garza-Ramos, Rafael, M.D Ramhmdani, Seba, M.D Kosztowski, Thomas, M.D Xu, Risheng, M.D., Ph.D Yassari, Reza, M.D Witham, Timothy F., M.D Bydon, Ali, M.D |
| description | Abstract Object To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. Methods A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. Results A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p |
| doi_str_mv | 10.1016/j.wneu.2017.05.166 |
| format | Article |
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Methods A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. Results A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p<0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared to 36.4% for patients with symptoms for over 12 months (p<0.001). Patients with symptoms for 12 months or less had a 59.6% gait recovery rate, compared to 24.2% in patients with symptoms for over 12 months (p<0.001). Having symptoms for over 12 months was independently associated with lower odds of improvement and recovery. Conclusions Patients with a higher preoperative Nurick grade and symptoms for over 12 months may have significantly lower odds of experiencing gait improvement or gait recovery after surgery for cervical myelopathy. This study's conclusion favors early intervention in patients with cervical myelopathy.</description><identifier>ISSN: 1878-8750</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2017.05.166</identifier><identifier>PMID: 28602883</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cervical decompression ; Cervical myelopathy ; Cervical Vertebrae - surgery ; Decompression, Surgical - methods ; Female ; Follow-Up Studies ; Gait Disorders, Neurologic - etiology ; Gait Disorders, Neurologic - surgery ; Gait impairment ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neurosurgery ; Nurick grade ; Outcome Assessment (Health Care) ; Recovery of Function - physiology ; Retrospective Studies ; Severity of Illness Index ; Spinal Cord Diseases - complications ; Spinal Cord Diseases - surgery</subject><ispartof>World neurosurgery, 2017-09, Vol.105, p.314-320</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-8dd103b1801caa35a89b25ff52544f09291c567e0bd3751cd74f14220138b41b3</citedby><cites>FETCH-LOGICAL-c411t-8dd103b1801caa35a89b25ff52544f09291c567e0bd3751cd74f14220138b41b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.wneu.2017.05.166$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28602883$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>De la Garza-Ramos, Rafael, M.D</creatorcontrib><creatorcontrib>Ramhmdani, Seba, M.D</creatorcontrib><creatorcontrib>Kosztowski, Thomas, M.D</creatorcontrib><creatorcontrib>Xu, Risheng, M.D., Ph.D</creatorcontrib><creatorcontrib>Yassari, Reza, M.D</creatorcontrib><creatorcontrib>Witham, Timothy F., M.D</creatorcontrib><creatorcontrib>Bydon, Ali, M.D</creatorcontrib><title>Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>Abstract Object To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. Methods A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. Results A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p<0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared to 36.4% for patients with symptoms for over 12 months (p<0.001). Patients with symptoms for 12 months or less had a 59.6% gait recovery rate, compared to 24.2% in patients with symptoms for over 12 months (p<0.001). Having symptoms for over 12 months was independently associated with lower odds of improvement and recovery. Conclusions Patients with a higher preoperative Nurick grade and symptoms for over 12 months may have significantly lower odds of experiencing gait improvement or gait recovery after surgery for cervical myelopathy. This study's conclusion favors early intervention in patients with cervical myelopathy.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cervical decompression</subject><subject>Cervical myelopathy</subject><subject>Cervical Vertebrae - surgery</subject><subject>Decompression, Surgical - methods</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gait Disorders, Neurologic - etiology</subject><subject>Gait Disorders, Neurologic - surgery</subject><subject>Gait impairment</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neurosurgery</subject><subject>Nurick grade</subject><subject>Outcome Assessment (Health Care)</subject><subject>Recovery of Function - physiology</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><subject>Spinal Cord Diseases - complications</subject><subject>Spinal Cord Diseases - surgery</subject><issn>1878-8750</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2L1TAUhosozjDOH3AhWbq5NadpmhREkMEvGFRQ1yFNTu_kTtvUJL1DF_53U-84CxdmkQTO8x44zymK50BLoNC8OpR3Ey5lRUGUlJfQNI-Kc5BC7qRo2scPf07PissYDzQfBrUU7GlxVsmGVlKy8-LX1-D3k4_JGXLUw4LE92QO6GcMOrkjks9LcOaW7IO2SPRkSXIjkjuXbkhcxzn5MRI3kTnTOKV4qhgMR2f0QMYVB59rN-uf7F67RNw4axfGTD8rnvR6iHh5_14UP96_-371cXf95cOnq7fXO1MDpJ20FijrQFIwWjOuZdtVvO95xeu6p23VguGNQNpZJjgYK-oe6iq7YbKroWMXxctT3zn4nwvGpEYXDQ6DntAvUUFLpWhFvjNanVATfIwBezUHN-qwKqBqM68OajOvNvOKcpXN59CL-_5LN6J9iPz1nIHXJwDzlEeHQUWTdRm0LqBJynr3__5v_ombwU2b4FtcMR78EqbsT4GKlaLq27b7bfUgGJWNbNlvwJ-rew</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>De la Garza-Ramos, Rafael, M.D</creator><creator>Ramhmdani, Seba, M.D</creator><creator>Kosztowski, Thomas, M.D</creator><creator>Xu, Risheng, M.D., Ph.D</creator><creator>Yassari, Reza, M.D</creator><creator>Witham, Timothy F., M.D</creator><creator>Bydon, Ali, M.D</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170901</creationdate><title>Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment</title><author>De la Garza-Ramos, Rafael, M.D ; Ramhmdani, Seba, M.D ; Kosztowski, Thomas, M.D ; Xu, Risheng, M.D., Ph.D ; Yassari, Reza, M.D ; Witham, Timothy F., M.D ; Bydon, Ali, M.D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-8dd103b1801caa35a89b25ff52544f09291c567e0bd3751cd74f14220138b41b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cervical decompression</topic><topic>Cervical myelopathy</topic><topic>Cervical Vertebrae - surgery</topic><topic>Decompression, Surgical - methods</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gait Disorders, Neurologic - etiology</topic><topic>Gait Disorders, Neurologic - surgery</topic><topic>Gait impairment</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neurosurgery</topic><topic>Nurick grade</topic><topic>Outcome Assessment (Health Care)</topic><topic>Recovery of Function - physiology</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><topic>Spinal Cord Diseases - complications</topic><topic>Spinal Cord Diseases - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>De la Garza-Ramos, Rafael, M.D</creatorcontrib><creatorcontrib>Ramhmdani, Seba, M.D</creatorcontrib><creatorcontrib>Kosztowski, Thomas, M.D</creatorcontrib><creatorcontrib>Xu, Risheng, M.D., Ph.D</creatorcontrib><creatorcontrib>Yassari, Reza, M.D</creatorcontrib><creatorcontrib>Witham, Timothy F., M.D</creatorcontrib><creatorcontrib>Bydon, Ali, M.D</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>De la Garza-Ramos, Rafael, M.D</au><au>Ramhmdani, Seba, M.D</au><au>Kosztowski, Thomas, M.D</au><au>Xu, Risheng, M.D., Ph.D</au><au>Yassari, Reza, M.D</au><au>Witham, Timothy F., M.D</au><au>Bydon, Ali, M.D</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>105</volume><spage>314</spage><epage>320</epage><pages>314-320</pages><issn>1878-8750</issn><eissn>1878-8769</eissn><abstract>Abstract Object To investigate the prognostic value of preoperative Nurick grade and time with symptoms for gait improvement and recovery in patients with ataxia secondary to cervical myelopathy. Methods A retrospective chart review of all adult patients who underwent surgical decompression for cervical myelopathy between 1996 and 2013 was performed. Only adults with a Nurick grade of at least 2 or worse were included. Outcome measures included gait improvement and recovery. Results A total of 170 patients were identified. Gait improvement and gait recovery occurred in 57.7% and 45.9% of patients, respectively. Time to improvement occurred as early as 1 month up to 24 months postoperatively. A higher preoperative Nurick grade was associated with lower odds of gait improvement (OR 0.74; 95% CI, 0.53 - 0.99, p=0.048) and gait recovery (OR 0.27; 95% CI, 0.17 - 0.43, p<0.001). The proportion of patients with symptoms for 12 months or less that experienced gait improvement was 71.2%, compared to 36.4% for patients with symptoms for over 12 months (p<0.001). Patients with symptoms for 12 months or less had a 59.6% gait recovery rate, compared to 24.2% in patients with symptoms for over 12 months (p<0.001). Having symptoms for over 12 months was independently associated with lower odds of improvement and recovery. Conclusions Patients with a higher preoperative Nurick grade and symptoms for over 12 months may have significantly lower odds of experiencing gait improvement or gait recovery after surgery for cervical myelopathy. This study's conclusion favors early intervention in patients with cervical myelopathy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28602883</pmid><doi>10.1016/j.wneu.2017.05.166</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Cervical decompression Cervical myelopathy Cervical Vertebrae - surgery Decompression, Surgical - methods Female Follow-Up Studies Gait Disorders, Neurologic - etiology Gait Disorders, Neurologic - surgery Gait impairment Humans Male Middle Aged Multivariate Analysis Neurosurgery Nurick grade Outcome Assessment (Health Care) Recovery of Function - physiology Retrospective Studies Severity of Illness Index Spinal Cord Diseases - complications Spinal Cord Diseases - surgery |
| title | Prognostic value of preoperative Nurick grade and time with symptoms in patients with cervical myelopathy and gait impairment |
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