Discrepancy Between Clinician- and Patient-Reported Definitions of Mild Degenerative Cervical Myelopathy and Surgical Outcomes.

Abstract

Study DesignProspective multicenter observational cohort study.ObjectiveTo redefine mild degenerative cervical myelopathy (DCM) using a patient-reported severity framework derived from Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) and to compare surgical outcomes with the conventional clinician-reported definition.MethodsPatients with DCM undergoing surgery at 10 spine centers were enrolled. Mild DCM was defined using two criteria: a clinician-reported definition based on Japanese Orthopaedic Association (JOA) score (≧ 14.5) and a patient-reported definition derived from principal component analysis of JOACMEQ domains and Numerical Rating Scale (NRS) pain scores. Patients were categorized into four groups: Dual-Mild, Clinician-Mild, Patient-Mild, and Non-Mild. Postoperative outcomes were assessed using achievement of minimum clinically important difference (MCID) for JOA score, JOACMEQ, NRS, and Short Form-36 (SF-36). Multivariable logistic regression models were used to estimate adjusted probabilities of MCID achievement.ResultsAmong 930 eligible patients, 122 met criteria for mild DCM by each definition. Patients classified as Patient-Mild demonstrated higher baseline function and lower pain scores but showed significantly lower adjusted probabilities of achieving MCID in pain-related outcomes and SF-36 physical component summary (PCS) (odds ratio for PCS, 0.346 [0.196-0.589]; p < 0.001). In contrast, Clinician-Mild status was associated with sustained postoperative improvement.ConclusionDefinitions of mild DCM differ substantially between clinician- and patient-reported criteria. Patients who perceive their disease as mild exhibit limited postoperative improvement. Incorporating patient-reported severity into preoperative assessment may better inform expectations and shared decision-making regarding surgery in mild DCM.