Quality of life indicators in assessing the results of various surgical treatment methods for cervical myelopathy

Quality of life indicators are widely used to determine the efficiency of various medical therapies for cervical myelopathy; however, but these have been insufficiently studied in assessing the results of surgical treatment for this pathology. In addition, the results of surgical treatment for cervical myelopathy are observed to be unsatisfactory in 15–20% of cases, which indicates the need to develop new techniques and to improve existing ones for its correction. Direct electrical stimulation of the spinal cord may become one of the promising areas.

Objective: to comparatively analyze the efficiency of various surgical treatments for cervical myelopathy, by assessing the quality of life indicators in the patients.

Patients and methods. The investigation enrolled 92 patients with cervical myelopathy: 29 (49.2%) patients underwent posterior spinal cord decompression via laminectomy; in 17 of them, that was supplemented with the electrodes placed on the posterior columns of the spinal cord for its postoperative direct electrical stimulation; 63 (50.8%) patients underwent anterior spinal cord decompression, 12 of them had electrodes placed on the anterior horns of the spinal cord.

Results and discussion. After posterior spinal cord decompression with laminectomy, there were increases in physical functioning from 36.7±2.1 to 49.6±3.1 arbitrary units (arb. unit) (p<0.05) and in role physical functioning from 39.4±2.6 to 51.3±2.6 arb. unit (p<0.05) and a decrease in pain sensations from 51.6±2.6 to 30.2±0.8 arb. unit (p<0.05). Electric stimulation of the spinal cord caused increases in physical functioning from 40.3±3.6 to 61.3±2.8 arb. unit (p<0.05) and in role physical functioning from 36.7±1.6 to 69.4±1.6 arb. unit (p<0.05) and a reduction in pain sensations from 49.8±2.4 to 21.0±1.2 arb. unit (p<0.05). The similar trend as also observed in anterior spinal cord decompression concurrent with corporodesis at the cervical level after direct electrical stimulation of the spinal cord. Physical functioning increased from 42.0±3.1 to 57.6±1.4 arb. unit (by 26.4%; p<0.05) and mental health improved (only by 14.3%). After isolated anterior spinal cord decompression with corporodesis, physical functioning was 48.4±0.9 arb. unit by the end of the third month follow-up (p<0.05); following that in combination with electrical stimulation, physical functioning was 57.6±1.4 arb. unit (p<0.05). The posttreatment levels of viability, social functioning, role emotional functioning, and mental health were significantly lower in patients with a disease duration of more than 6 years than in those with that of less than 3 years.

Conclusion. Posterior and anterior spinal cord decompression with laminectomy for cervical myelopathy increases the indicators of physical functioning and role physical functioning and reduces pain sensations. The additional use of electrical stimulation of the spinal cord allows one to increase role physical functioning.

1. Mitskevich VA. Pathology of the cervical spine. Instability of the cervical spine. Praktikuyushchemu nevrologu. 2005;(2):18-20. (In Russ.).

2. Parfenov VA, Gerasimova ON. Management of patients with back pain in outpatient practice. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2010;2(4):65–71. (In Russ.). doi: 10.14412/2074-2711-2010-120

3. Chekhonatskii AA, Sholomov II, Ninel' VG. Some aspects of diagnosis and treatment of radiculopathy in patients with degenerative-dystrophic changes in the cervical spine. Genii ortopedii. 2005;(2):82-4. (In Russ.).

4. Baptiste DC. Pathophysiology of cervical myelopathy. Spine J. 2006 Nov-Dec;6(6 Suppl): 190S-197S.

5. Golovacheva VA, Parfenov VA. Depression in neurological practice: prevalence, diagnosis, treatment standards and new pharmacotherapy opportunities. Meditsinskii sovet. 2015;(5): 55-61. (In Russ.).

6. Zaitsev VP, Tyurina OG, Aivazyan TA, et al. Features of pain perception and psychological status of patients with osteochondrosis of the spine with pain syndrome. Voprosy kurortologii, fizioterapii i lechebnoi fizkul'tury. 2002;(6): 30-3. (In Russ.).

7. Yakhno NN, Kukushkin ML. Dysfunctional mechanism of chronic pain. Rossiiskii zhurnal boli. 2014;(1):23–4. (In Russ.).

8. Yakhno NN, Preobrazhenskaya IS, Zakharov VV, et al. Prevalence of cognitive impairments in neurological diseases: Analysis of the activities of a specialized outpatient reception office. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2):30-5. (In Russ.) doi: 10.14412/2074-2711-2012-378

9. Bruehl S. Chung OY. Psychological and behavioral aspects of complex regional pain syndrome management. Clin J Pain. 2006 Jun; 22(5):430-7.

10. DePalma MJ, Ketchum JM, Saullo T. What is the source of chronic low back pain and does age play a role? Pain Med. 2011 Feb;12(2): 224-33. doi: 10.1111/j.1526-4637.2010.01045.x. Epub 2011 Jan 25.

11. Parfenov VA, Gerasimova ON. Nonspecific back pain in outpatient practice, the use of Airtal and Midokalm. Spravochnik poliklinicheskogo vracha. 2013;(1):34–7. (In Russ.).

12. Yakhno NN, Kukushkin ML. Chronic pain: biomedical and socio-economic aspects. Vestnik RAMN. 2012;(9):54–8. (In Russ.).

13. Foster N, Hartvigsen J, Croft P. Taking responsibility for the early assessment and treatment of patients with musculoskeletal pain: a review and critical analysis. Arthritis Res Ther. 2012 Feb 29;14(1):205. doi: 10.1186/ar3743.

14. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. Spine J. 2003 Nov-Dec;3(6):460-5.

15. Chekhonatskii AA, Nikolenko VN, Chekhonatskii VA, et al. Influence of emotional status and quality of life in patients with cervical disc herniation on the accuracy of topical diagnosis. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):30-5. (In Russ.). doi: 10.14412/2074-2711-2018-4-30-35

16. Yakhno NN. Neurology of pain. Rossiiskii zhurnal boli. 2014;(2):3–5. (In Russ.).

17. Casey E. Natural history of radiculopathy. Phys Med Rehabil Clin N Am. 2011 Feb;22(1): 1-5. doi: 10.1016/j.pmr.2010.10.001. Epub 2010 Dec 3.

18. Schneiderhan J, Orizondo C. Chronic pain: How to approach these 3 common conditions. J Fam Pract. 2017 Mar;66(3):145-157.

19. Chekhonatskii AA, Sholomov II, Bubashvili AI. The effectiveness of direct electrical stimulation of the spinal cord in the treatment of neurological complications of cervical osteochondrosis. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2011;111(6):33-6. (In Russ.).

20. Cagnie B, Castelein B, Pollie F, et al. Evidence for the use of ischemic compression and dry needling in the management of trigger points of the upper trapezius in patients with neck pain: a systematic review. Am J Phys Med Rehabil. 2015 Jul;94(7):573-83. doi: 10.1097/PHM.0000000000000266.

21. Steffens D, Hancock MJ, Maher CG, et al. Does magnetic resonance imaging predict future low back pain? A systematic review. Eur J Pain. 2014 Jul;18(6):755-65. doi: 10.1002/j.1532-2149.2013.00427.x. Epub 2013 Nov 26.

22. Chekhonatskii AA, Toma VI, Abel'tsev VP, et al. The possibility of using electrostimulation of the spinal cord in the treatment of neurological disorders in patients with cervical osteochondrosis. Kremlevskaya meditsina. Klinicheskii vestnik. 2018;(3):117-22. (In Russ.).

23. Herman R, He J, Luzansky S, et al. Spinal cord stimulation facilitates functional walking in a chronic, incomplete spinal cord injured. Spinal Cord. 2002 Feb;40(2):65-8.