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Study Design. Narrative review. Objective. To identify suitable outcome measures that can be used to quantify neurological and functional impairment in the management of cervical spondylotic myelopathy (CSM). Summary of Background Data. CSM is the leading cause of acquired spinal cord disability, causing varying degrees of neurological impairment which impact on independence and quality of life. Because this impairment can have a heterogeneous presentation, a single outcome measure cannot define the broad range of deficits seen in this population. Therefore, it is necessary to define outcome measures that characterize the deficits with greater validity and sensitivity. Methods. This review was conducted in 3 stages. Stage I: To evaluate the current use of outcome measures in CSM, PubMed was searched using the name of the outcome measure and the common abbreviation combined with "CSM" or "myelopathy." Stage II: Having identified a lack of appropriate outcome measures, we constructed criteria by which measures appropriate for assessing the various aspects of CSM could be identified. Stage III: A second literature search was then conducted looking at specified outcomes that met these criteria. All literature was reviewed to determine specificity and psychometric properties of outcomes for CSM. Results. Nurick grade, modified Japanese Orthopaedic Association Scale, visual analogue scale WAS) for pain, Short Form (36) Health Survey (SF-36), and Neck Disability Index were the most commonly cited measures. The Short-Form 36 Health Survey and Myelopathy Disability Index have been validated in the CSM population with multiple studies, whereas the modified Japanese Orthopaedic Association Scale score, Nurick grade, and European Myelopathy Scale each had only one study assessing psychometric characteristics. No validity, reliability, or responsiveness studies were found for the VAS or Neck Disability Index in the CSM population. Conclusion. We recommend that the modified Japanese Orthopaedic Association Scale, Nurick grade, Myelopathy Disability Index, Neck Disability Index, and 30-Meter Walk Test are most appropriate for the assessment of CSM. However, 6 additional outcome measures (QuickDASH, Berg Balance Scale, Graded Redefined Assessment of Strength Sensibility and Prehension, Grip Dynamometer, and GAITRite Anlaysis) were identified, which provide complementary assessments for CSM. Summary Statements. There does not exist a single or composite of outcome instruments that measures myelopathy impairment, function/disability, and participation that have also demonstrated reliability, validity, and responsiveness in a CSM population. More work in the development and psychometric evaluation of new or existing measures is necessary to identify the ideal composite of measures to be used in the clinical and research settings. * The mJOA, Nurick grade, NDI, MDI, and 3OMWT should be adopted in any clinical practice that treats CSM both for screening and clinical follow-up. * We propose that clinicians and researchers consider using the ancillary measures identified, such as the QuickDASH, Berg Balance Scale, GRASSP version 1.0, Grip Strength, and GAITRite Analysis. * It is highly recommended that baseline and follow-up measurements should be performed in patients with CSM. [ABSTRACT FROM AUTHOR]

Study Design. A blinded observational study of consecutive patients, prospectively enrolled and followed up to 1 year postoperatively. Objective. To assess whether quantitative assessment of preoperative magnetic resonance imaging (MRI) predicts baseline patient status and postoperative neurological recovery. Summary of Background Data. Factors that can predict neurological recovery in patients with cervical spondylotic myelopathy (CSM) postoperatively are of great interest. Currently, the literature regarding the significance of MRI signal changes in relation to prognosis is inconsistent and conflicting. Methods. A total of 57 consecutive patients with CSM were studied preoperatively and 1 year postoperatively. Modified Japanese Orthopaedic Association (mJOA), Nurick Grade, SF-36, neck disability index, 30-meter walk cadence (Wc) and time (Wt), grip strength, and Berg Balance Scale were administered at baseline and 1 year after surgery. Preoperative status and postoperative recovery were assessed in relation to quantitative MRI measurements pre- and postoperatively using univariate and multivariate analysis. Results. LowT1 signal change preoperatively was associated with a lower mJOA (P = 0.0030), higher Nurick Grade (P = 0.0298), decreased grip (P = 0.0152), impaired Wt, Wc (P ≤ 0.0001) and poor Berg Balance Scale (P = 0.0005) at baseline. Focal high T2 signal was associated with lower mJOA scores and higher Nurick Grade compared with diffuse T2 (P = 0.0035 P = 0.0079) or no T2 signal (P = 0.0680 P = 0.0122). Preoperative segmentation of T2 signal, showed a significant increase in Wt, Wc, and Berg Balance Scale (P = 0.0266; P = 0.0167; P = 0.0042). Preoperative T1 signal was associated with lower postoperative grip (P = 0.0260), greater Wt, Wc (P = 0.0360, P = 0.0090). Preoperative focal T2 signal had a significant association with poorer postoperative Wt, Wc (P = 0.0220) and Nurick Grade (P = 0.0230). Preoperative maximal cord compromise was negatively correlated with postoperative SF-36 mental score (P = 0.0130). Conclusion. MRI signal changes are predictive of baseline neurological status and postoperative recovery. MRI indicators of poorer outcome include the presence of low T1 signal, focal increased T2 signal and segmentation of T2 signal changes. [ABSTRACT FROM AUTHOR]