Spinal cord status assessment and early interventional personalized rehabilitation after endoscopic surgery for cervical compressive myelopathy: a randomized trial.

Abstract

Cervical compressive myelopathy (CCM), frequently arising from spinal degeneration, results in significant motor and sensory deficits. Currently, there is a lack of precise prognostic evaluation methods following decompression surgery for CCM, which hinders the optimization of personalized rehabilitation therapy. However, the combination of intraoperative endoscopic visualization of dural sac compression morphology and electrophysiological functional assessment holds promise in addressing this gap. To determine whether a personalized rehabilitation strategy, informed by intraoperative endoscopic and electrophysiological assessments, enhances postoperative functional outcomes in CCM patients compared to traditional rehabilitation after canal decompression surgery. Prospective single-center randomized controlled study, trial registration: ChiCTR2400081458. Seventy-eight patients underwent spinal decompression surgery at The Sixth Medical Center of Chinese PLA General Hospital. The inclusion criteria included a diagnosis of CCM due to spondylosis or ossification of the longitudinal ligament. Participants were excluded if they had prior spinal surgeries or comorbidities unrelated to CCM. The primary outcome was the Japanese Orthopaedic Association (JOA) score, assessing spinal function. Secondary outcomes included the Neck Disability Index (NDI), Visual Analogue Scale (VAS) for pain, and three-dimensional gait analysis. This study was a double-blind randomized controlled trial comparing two postoperative rehabilitation strategies for patients with CCM following endoscopic spinal decompression surgery. After surgery, patients were randomly assigned to two groups. The experimental group received personalized rehabilitation based on real-time intraoperative spinal cord status assessments, using a combination of endoscopic visualization and electrophysiological grading. Interventions included lower limb exoskeleton-assisted walking and targeted motor function training. The control group received conventional standard rehabilitation treatment. Both groups were assessed using the JOA, NDI, and VAS scores before rehabilitation, 1 month, 3 months, and 12 months after the start of rehabilitation. Additionally, gait analysis (including stride frequency, gait velocity, and stride length) was performed before and 3 months after the start of rehabilitation to evaluate the clinical rehabilitation outcomes in both groups. Both groups showed significant improvements in JOA, NDI, VAS scores, and gait tests during the postoperative rehabilitation process. The experimental group demonstrated a more substantial increase in the primary outcome measure, the JOA score (12 months: 4.79±0.74 vs 3.53±0.93, p<.05). Additionally, the experimental group exhibited notable improvements in both stride frequency and gait velocity (3MO: Stride frequency (3.76±0.23 vs 1.05±0.07) and Gait velocity (4.53±0.63 vs 4.21±0.43), p<.05). The spinal cord status assessment methods based on spinal endoscopy and electrophysiological techniques can effectively evaluate the condition of the spinal cord. When combined with personalized rehabilitation strategies tailored to these assessments, they can significantly enhance the postoperative spinal cord function recovery in CCM patients, providing superior clinical rehabilitation outcomes compared to traditional rehabilitation methods.