The role of comprehensive rehabilitation in the care of degenerative cervical myelopathy

Spinal Cord, 2024 · DOI: https://doi.org/10.1038/s41393-024-00965-y · Published: March 4, 2024

Spinal Cord Injury Spinal Disorders Rehabilitation

Simple Explanation

This study investigates the impact of comprehensive rehabilitation on individuals with Degenerative Cervical Myelopathy (DCM) following spinal surgery. DCM is a condition that affects the spinal cord due to degenerative changes in the cervical spine. The study aims to determine if comprehensive rehabilitation, which involves a multidisciplinary team and various therapies, can improve daily performance for people with DCM, beyond the improvements gained from surgery alone. The findings suggest that comprehensive rehabilitation can indeed lead to considerable functional improvement for individuals with DCM, highlighting its potential role in DCM care, even before surgery is considered.

Study Duration

9 Years

Participants

116 DCM inpatients who underwent comprehensive rehabilitation after spinal surgery

Evidence Level

Retrospective cohort study

Key Findings

1
The Spinal Cord Injury Ability Realization Measurement Index (SCI-ARMI) increased during rehabilitation, indicating an improvement in the realization of potential performance.
2
A significant portion (71%) of the improvement in daily functioning during rehabilitation was attributed to improved ability realization, rather than neurological motor improvement.
3
The functional gain achieved through rehabilitation showed only a weak negative correlation with the time from spinal surgery to rehabilitation, suggesting that the benefits of rehabilitation are independent of the timing of surgery.

Research Summary

This retrospective cohort study assessed the contribution of comprehensive rehabilitation to improving disability in patients with DCM after spinal surgery. The results demonstrated that comprehensive rehabilitation significantly improved functional abilities and ability realization in DCM patients, beyond the improvements from surgery alone. The authors suggest considering comprehensive rehabilitation as a viable conservative care option for DCM patients, potentially even before surgical intervention is pursued.

Practical Implications

Rehabilitation as Primary Treatment

Comprehensive rehabilitation can be considered as an initial treatment option for DCM, potentially delaying or avoiding surgery in some cases.

Improved Guidelines for DCM Care

Current guidelines for DCM care should be modified to include quantitative neurological and performance assessments, and to consider comprehensive rehabilitation as a primary intervention.

Post-operative Rehabilitation

Following surgical intervention for DCM, patients should be referred to a spinal rehabilitation unit for assessment and tailored rehabilitation programs.

Study Limitations

1
Lack of a control group receiving only surgical or non-surgical treatment.
2
The retrospective nature of the study design.
3
Generalizability to all individuals with DCM needs further validation through comparative studies.

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