Gait Function Outcomes and Prognostic Factors Following Laminoplasty for Cervical Spondylotic Myelopathy in Patients Who Were Nonambulatory But Were Ambulatory Before Symptom Progression.

Abstract

Retrospective study. To investigate gait function outcomes following laminoplasty and related prognostic factors in nonambulatory patients with cervical spondylotic myelopathy (CSM). The extent to which gait functional improvement can be expected after surgery in nonambulatory patients with CSM remains poorly understood. We included 83 nonambulatory patients (48 men and 35 women; mean age: 77.2 y) with a baseline Japanese Orthopedic Association motor function subscore of the lower extremity (JOA-LE) of 0 or 1. JOA-LE and total scores assessed clinical outcomes preoperatively and at 1 year postoperatively. Multivariate logistic regression analysis was performed to identify predictors of favorable gait function outcomes (achievement of postoperative JOA-LE ≥2). Overall, 34 patients (41.0%) had favorable outcomes and 49 had unfavorable outcomes, with postoperative JOA-LE ≤1. Significantly more patients with baseline JOA-LE of 1 achieved favorable outcomes than those with baseline JOA-LE of 0 (52.9% vs. 21.9%, P<0.001). The mean JOA recovery rate was 37.4±23.7%, and the minimum clinically important difference in success rate was 26.5%. Patients with favorable outcomes had a significantly lower body mass index, shorter symptom duration, better baseline JOA-LE, and less frequent grade 2 increased intramedullary signal intensity on magnetic resonance imaging than those with unfavorable outcomes. Favorable outcomes were significantly and independently predicted by shorter symptom duration, with an optimal threshold of 3 months, and better baseline JOA-LE. Only 41.2% of patients with a baseline JOA-LE of 0 achieved a favorable outcome, despite them undergoing surgery within 3 months of symptom onset. Laminoplasty may improve gait function and alleviate myelopathy in nonambulatory patients with CSM. Surgical intervention within 3 months of symptom exacerbation is recommended to mitigate walking disability; however, it presents limitations and challenges, particularly in patients who could not ambulate, even with support, before surgery. Level III.