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Urinary Control in Cervical Myelopathy: Does It Improve Post-Surgery? A Quality Outcomes Database (QOD) Study

Wednesday, February 21, 2024

Presenting Author(s)

Raj S. Lavadi, M.B.B.S.

Postdoctoral Research Fellow
University of Pittsburgh School of Medicine
Rockaway, NJ, US

Co-Author(s)

SS

Saman Shabani, M.D.

Assistant Professor
Medical College of Wisconsin
San Francisco, California, United States
Nitin Agarwal, MD (he/him/his)

Associate Professor
University of Pittsburgh Department of Neurosurgery
Pittsburgh, PA, US
VL

Vivian P. Le, MPH

Clinical Research Coordinator Supervisor
University of California, San Francisco
New Haven, Connecticut, United States
Andrew K. Chan, MD

Assistant Professor of Neurological Surgery
Columbia University Irving Medical Center
New York, NY, US
Michael Y. Wang, MD

Professor
University of Miami
Miami, FL, US
Regis William Haid, Jr., MD

Neurosurgeon
Atlanta Brain and Spine
Atlanta, Georgia, United States
John Knightly, MD

Director of Neurosurgery
Atlantic Neurosurgical Specialists
Morristown, New Jersey, United States
Oren Gottfried, MD (he/him/his)

Professor of Neurosurgery
Duke University
Durham, NC, US
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, North Carolina, United States
MS

Mark Shaffrey, MD

Chair - Department of Neurosurgery
University of Virginia
Charlottesville, Virginia, United States
Paul Park, MD

Neurosurgeon
Semmes Murphey Clinic
MEMPHIS, Tennessee, United States
Kevin T. Foley, MD

Professor
Semmes-Murphey Neurologic and Spine Institute, University of Tennessee
Memphis, TN, US
Domagoj Coric, MD

Neurosurgeon
Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Cheerag Upadhyaya, MD, MBA (he/him/his)

Clinical Associate Professor
University of North Carolina- Chapel Hill
Chapel Hill, North Carolina, United States
Eric Potts, MD

Neurosurgeon
Goodman Campbell Brain and Spine
Carmel, IN, US
Juan S. Uribe, MD

Neurosurgeon
Barrow Neurological Insitute
Phoenix, Arizona, United States
Jay D. Turner, MD, PhD

Neurosurgery Faculty
Barrow Neurological Institute
Phoenix, AZ, US
Luis M. Tumialán, MD

Professor of Neurosurgery
Barrow Brain and Spine
Paradise Valley, Arizona, United States
Dean Chou, MD

Chief of the Spine Division, Professor, and Vice Chair of Neurosurgery
Columbia University
New York, NY, US
KF

Kai-Ming Fu, MD, PhD

Associate Professor
Weill Cornell Medical Center
New York, NY, US
Anthony L. Asher, MD (he/him/his)

Clinical Professor
Neuroscience Institute, Carolina Neurosurgery & Spine Associates
Charlotte, NC, US
Erica F. Bisson, MD, MPH

Professor
University of Utah
Salt Lake City, UT, US
Mohamad Bydon, MD

Professor of Neurosurgery
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55902, USA
Rochester, MN, US
Praveen V. Mummaneni, MD, MBA

Joan O'Reilly Endowed Professor and Vice Chair of Neurosurgery
Department of Neurological Surgery, University of California, San Francisco
San Francisco, CA, US

Introduction: Cervical spondylotic myelopathy (CSM) can be associated with urinary dysfunction leading to inability or marked difficulty with micturition. This study aimed to evaluate the urinary dysfunction, long-term prognosis, and recovery in patients with CSM, following surgical intervention.

Methods: The CSM cases of the Quality Outcomes Database Spine Core Study Group were analyzed. Urinary control was assessed using the modified Japanese Orthopaedic Association (mJOA) “Urinary Function Subscore.” Improvement was defined as a minimum of one-point improvement at 2-year follow-up in the mJOA urinary function subscore. Univariate and multivariate analyses were conducted as appropriate.

Results: Out of 1,141 patients, 772 (67.7%) patients were identified with a minimum 2-year follow-up out of which 249 (32.3%) reported baseline urinary dysfunction. Of those, 193 (77.5%) patients had improvement in urinary function postoperatively. Of those that improved their function, a larger proportion were female (54.9% vs. 45.8%, p = 0.03). Apart from gender, demographic characteristics of patients who experienced urinary function improvement versus those who did not were similar. Patients who experienced urinary function improvement had lower overall baseline mJOA scores (10.1 vs. 12.8, p < 0.01). There was no significant difference in total mJOA scores at 2-year follow-up between the improved and not-improved urinary function cohorts. Both cohorts reported similar rates of postoperative satisfaction (NASS 1-2) (89.1% vs. 85.9%; p=0.26).

Conclusion : Among the one-third of patients with CSM experiencing urinary dysfunction, nearly 78% will achieve improved urinary function at 2-years postoperative follow-up. Women are more likely to improve this function; lack of improvement in men could be attributed to prostate issues. Patients with and without improvements in urinary function are equally satisfied with their surgery and report similar outcomes on long-term follow-up.