Hand Dexterity Recovery Capacity for Degenerative Cervical Myelopathy With Varying Levels of Impairment: A Prospective 1-Year Follow-Up Study.

Abstract

Objective: This study aimed to elucidate the hand function recovery capacity of Degenerative Cervical Myelopathy (DCM) patients with different severities of hand dexterity impairment.

Methods: Hand functional outcome measures such as the 10s-G&R test, modified Japanese Orthopedic Association (mJOA) upper extremity score and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) Upper Extremity Function were collected before surgery and at the 1-year follow-up. A total of 102 DCM patients were categorized into Mild, Moderate and Severe group based on the preoperative 10s-G&R test result. Hand functional parameters were compared across the three groups. Multivariate linear regression was conducted to explore predictive factors. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive efficacy of the preoperative 10s-G&R test and establish the cut-off value for incomplete recovery of hand dexterity.

Results: At the 1-year follow-up, significant improvements were observed in all hand functional parameters across all three groups. However, the incomplete recovery rates of the Mild/Moderate/Severe group were 26.67%, 46.88%, and 57.50%, respectively (P<0.05). Multivariate regression revealed that preoperative 10s-G&R test result, age, Hoffmann's sign, duration of symptom, and mJOA Upper score serve as significant predictors for postoperative 10s-G&R test outcomes. Patients with a preoperative 10s-G&R test < 15 cycles have a 1.9 times higher risk of incomplete recovery of hand function (P = 0.005).

Conclusion: Most patients, regardless of their preoperative hand function, exhibit potential for improvement in hand dexterity. However, worse initial hand dexterity correlates with poorer outcomes.