Temporal changes of hand dexterity in patients with cervical spondylotic myelopathy after decompression surgery

English Keywords:Cervical spondylotic myelopathy  Hand dexterity  Patient-reported outcome measures  10-second Grip and Release Test  Prediction model

English Abstract:

  【Abstract】 Objectives: To elucidate the temporal pattern of hand dexterity changes in patients with cervical spondylotic myelopathy(CSM) one year after decompression surgery and to develop and validate a predictive model for hand dexterity improvement. Methods: A total of 136 adult patients with CSM(70 males and 66 females; mean age 56.37±11.12 years) treated in our hospital were prospectively enrolled between October 2021 and October 2022. Hand dexterity was assessed using the 10-second grip and release(10-s G&R) test, the modified Japanese Orthopaedic Association(mJOA) upper extremity motor function score, and the JOA cervical myelopathy evaluation questionnaire(JOACMEQ) upper extremity function before operation, and at 6 and 12 months after operation. A one-way ANOVA was conducted to examine the temporal pattern of hand function improvement. Logistic regression analysis was performed to identify risk factors and develop a predictive model for postoperative hand dexterity impairment. The model′s discrimination was assessed using receiver operating characteristic(ROC) curve and area under curve(AUC) analysis. Results: At 6 months after operation, significant improvements were observed in mJOA score(from 13.09±2.42 to 16.64±1.42分), mJOA upper extremity motor function score(from 3.90±0.89 to 4.77±0.48), JOACMEQ upper extremity function score(from 76.97±19.30 to 90.45±14.70), and 10-s G&R test result(from 14.41±3.14 cycles to 18.16±4.63 cycles)(all P<0.001); At 12 months after operation, the 10-s G&R test result further increased to 18.16±4.63 cycles(P=0.038), though no significant changes were noted in the subjective scores. The cycles of preoperative 10-s G&R test, as well as age and smoking status, were identified as the risk factors for hand dexterity impairment one year after surgery. The prediction model was validated with an AUC of 0.780(95%CI=0.665-0.894). Conclusions: Regarding the hand function of CSM patients after decompression surgery, subjective measurements typically stabilize at 6 months, while objective measurements continue to improve at 1 year. Based on the cycles of preoperative 10-s G&R test, age, and smoking status, the improvement in the cycles of the 10-s G&R test one year post-surgery can be predicted.