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Life expectancy in patients with degenerative cervical myelopathy is currently reduced but can be restored with timely treatment.

Published version
Peer-reviewed

Repository DOI


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Authors

Stubbs, Daniel 
Gillespie, Conor S 
Grodzinski, Ben 
Venkatesh, Ashwin 

Abstract

PURPOSE: Degenerative cervical myelopathy is a progressive slow-motion spinal cord injury. Surgery is the mainstay of treatment. Baseline disability predicts surgical recovery; therefore, timely treatment is critical to restoring function. However, current challenges mean most patients present with advanced disease and are instead left with life changing disabilities. While short-term mortality is rarely reported, the long-term effects of this on life expectancy are unknown, including whether function could be modifiable with timely treatment. This article investigates the effect of DCM on life expectancy. METHODS: The survival of patients from an observational study of patients undergoing surgery from 1994 to 2007 was compared to their expected survival using a gender- and aged -matched cohort. Comparisons were made by one sample log-rank test and standardised mortality ratios. Factors associated with survival were explored using a Cox regression analysis, including disease severity. RESULTS: A total of 357 patients were included in the analysis. After a median follow-up of 15.3 years, 135 of 349 patients had died; 114.7 deaths would have been expected. The DCM cohort had an increased risk of death compared to the non-DCM cohort (standardised mortality ratio 1.18 [95% CI: 1.02-1.34]. Age at operation 1.08 (95% CI: 1.07 to 1.1, p < 0.001) and severe DCM 1.6 (95% CI: 1.06 to 2.3, p = 0.02) were associated with worse survival (N = 287). In those surviving at least 2 years after surgery, only severe DCM was associated with conditional survival (HR 1.6, 95% CI 1.04 2.4, p = 0.03). CONCLUSION: Life expectancy is reduced in those undergoing surgery for DCM. This is driven by premature mortality among those left with severe disability. As disability can be reduced with timely treatment, these findings reinforce the need for collective and global action to raise awareness of DCM and enable early diagnosis.

Description

Acknowledgements: This research aligns with the AO Spine RECODE DCM, James Lind Alliance top research priority individualizing surgery and awareness selected by people living and working with DCM. For further information on how this process was conducted, why these questions were prioritised, and global updates on currently aligned research, please visit aospine.org/recode/individualizing-surgery or aospine.org/recode/awareness.

Keywords

Cervical myelopathy, Cervical Spondylosis, Cervical Stenosis, Degeneration, Degenerative Cervical Myelopathy, Ossification of the posterior longitudinal ligament, Survival, Humans, Aged, Cervical Vertebrae, Spinal Cord Diseases, Spinal Cord Injuries, Neck, Life Expectancy

Journal Title

Acta Neurochir (Wien)

Conference Name

Journal ISSN

0001-6268
0942-0940

Volume Title

165

Publisher

Springer Science and Business Media LLC
Sponsorship
Wellcome Trust (204017/Z/16/Z)