Impact of Preoperative Inability to Walk on Surgical Outcomes in Degenerative Cervical Myelopathy: A Prospective Multicenter Study.

Abstract

Prospective multicenter cohort study. 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. 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. 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. 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. 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. II.