Spine - 2026-08-15 - Journal Article
Symptom Duration of One Year or More Is Associated With Worse Absolute Outcomes but Similar Clinically Meaningful Improvement After ACDF for Cervical Myelopathy.
Lee Y, Baek G, Ng M, Dalton J, Hitchner M, Eichbaum Y, Green WA, Mathew J, Giakas A, Thomas G, Hilibrand A, Vaccaro A, Cha T, Schroeder G, Kepler C
Topics
Key Takeaway
Patients with ≥1 year of myelopathy symptoms had worse absolute NDI and VAS Neck scores postoperatively but achieved MCID at comparable or higher rates versus those with <1 year of symptoms, with no difference in mJOA recovery at any time point.
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Summary
This study stratified 139 ACDF-for-myelopathy patients by symptom duration (<1 year, n=75 vs. ≥1 year, n=64) and compared PROMs and mJOA at 3, 6, and 12 months. The <1-year cohort had superior absolute scores at select time points (3-month PCS 38.5 vs. 34.3; 6-month MCS 55.1 vs. 50.2), but the ≥1-year cohort achieved MCID for VAS Neck at higher rates at 6 and 12 months. mJOA scores and MCID achievement did not differ between groups at any time point.
Key Limitation
The 1-year duration cutoff is arbitrary and coarser than the 24-month threshold validated in prior radiculopathy literature, potentially masking a dose-response relationship between symptom duration and outcome within the ≥1-year cohort.
Original Abstract
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
To evaluate the association between preoperative symptom duration and neurologic and patient-reported outcomes after anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM).
SUMMARY OF BACKGROUND DATA
Prior studies suggest longer duration of preoperative myelopathic symptoms may impair neurologic recovery after surgery, but its relationship with patient-reported outcome measures (PROMs) and clinically meaningful improvement remains unclear.
METHODS
Adult patients undergoing primary ACDF for myelopathy at a single academic institution (2017-2023) were identified. Patients were stratified by symptom duration (<1 y vs. ≥1 y). Demographic, surgical, and clinical outcomes were collected. PROMs included Short Form-12 mental and physical component scores (MCS, PCS), Visual Analog Scale (VAS) Neck and Arm, Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores collected preoperatively and at 3, 6, and 12 months postoperatively. Achievement of minimal clinically important difference (MCID) was assessed.
RESULTS
A total of 139 patients met inclusion criteria, including 75 (54.0%) with symptom duration <1 year. Patients with <1 year of symptoms were older, less likely to have commercial insurance, less likely to undergo inpatient surgery, and underwent fusion of fewer levels. Six-month MCS (55.1 vs. 50.2, P =0.038) and 3-month PCS (38.5 vs. 34.3, P =0.030) were greater in the <1-year cohort. VAS Neck and NDI scores were lower at select postoperative time points in the <1-year cohort. The ≥1-year cohort demonstrated higher rates of MCID achievement for VAS Neck at 6 and 12 months. No differences were observed in mJOA scores or MCID achievement for other outcomes.
CONCLUSIONS
Longer preoperative symptom duration was associated with worse absolute postoperative pain and disability but not neurologic recovery, with largely comparable rates of MCID achievement after ACDF. These findings suggest that delayed presentation does not preclude meaningful postoperative improvement for cervical myelopathy.
LEVEL OF EVIDENCE
Level III.