Symptom duration and postoperative outcomes in degenerative cervical myelopathy: a systematic review and meta-analysis.
Michał Szymoniuk, Wojciech Czyżewski, Marek Kochański et al.
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In 30 seconds
This systematic review and meta-analysis examined whether symptom duration is associated with outcomes after surgery for degenerative cervical myelopathy (DCM). It included 14 studies with 3162 patients whose postoperative outcomes were assessed using the mJOA score after at least 12 months. Longer symptom duration was associated with poorer postoperative mJOA outcomes in both univariate (OR: 2.15; 95% CI: 1.64-2.81) and multivariate analyses (OR: 1.78; 95% CI: 1.23-2.57). The authors could not recommend an optimal symptom-duration threshold for surgery.
Key findings
- Longer symptom duration was associated with postoperative mJOA outcomes in univariate analysis (OR: 2.15; 95% CI: 1.64-2.81) and multivariate analysis (OR: 1.78; 95% CI: 1.23-2.57).
- Earlier surgery was associated with reduced neck pain and disability on the NDI (OR: 1.56; 95% CI: 1.24-1.95), but not with EQ-5D quality of life (OR: 1.47; 95% CI: 0.74-2.89).
- Longer symptom duration was linked to worse mJOA outcomes at 6- and 12-month cut-offs; after excluding high-risk-of-bias studies, this association remained only at 12 months.
Why it matters
The findings support considering symptom duration when discussing expected surgical outcomes and planning care for DCM. They suggest that prolonged symptoms may be associated with poorer neurological recovery, while also showing that evidence does not establish a specific point by which surgery should occur. This distinction matters when interpreting timing evidence and counseling about uncertainty.
What to keep in mind
The authors state that limitations in published data prevent recommendation of an optimal symptom-duration threshold; the subgroup difference between cut-offs was not significant (p = 0.89).