Gait Function Outcomes and Prognostic Factors Following Laminoplasty for Cervical Spondylotic Myelopathy in Patients Who Were Nonambulatory But Were Ambulatory Before Symptom Progression

STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate gait function outcomes following laminoplasty and related prognostic factors in nonambulatory patients with cervical spondylotic myelopathy (CSM). SUMMARY OF BACKGROUND DATA: The extent to which gait functional improvement can be expected after surgery in nonambulatory patients with CSM remains poorly understood. METHODS: We included 83 nonambulatory patients (48 men and 35 women; mean age: 77.2 y) with a baseline Japanese Orthopedic Association motor function subscore of the lower extremity (JOA-LE) of 0 or 1. JOA-LE and total scores assessed clinical outcomes preoperatively and at 1 year postoperatively. Multivariate logistic regression analysis was performed to identify predictors of favorable gait function outcomes (achievement of postoperative JOA-LE ≥2). RESULTS: Overall, 34 patients (41.0%) had favorable outcomes and 49 had unfavorable outcomes, with postoperative JOA-LE ≤1. Significantly more patients with baseline JOA-LE of 1 achieved favorable outcomes than those with baseline JOA-LE of 0 (52.9% vs. 21.9%, P <0.001). The mean JOA recovery rate was 37.4±23.7%, and the minimum clinically important difference in success rate was 26.5%. Patients with favorable outcomes had a significantly lower body mass index, shorter symptom duration, better baseline JOA-LE, and less frequent grade 2 increased intramedullary signal intensity on magnetic resonance imaging than those with unfavorable outcomes. Favorable outcomes were significantly and independently predicted by shorter symptom duration, with an optimal threshold of 3 months, and better baseline JOA-LE. Only 41.2% of patients with a baseline JOA-LE of 0 achieved a favorable outcome, despite them undergoing surgery within 3 months of symptom onset. CONCLUSIONS: Laminoplasty may improve gait function and alleviate myelopathy in nonambulatory patients with CSM. Surgical intervention within 3 months of symptom exacerbation is recommended to mitigate walking disability; however, it presents limitations and challenges, particularly in patients who could not ambulate, even with support, before surgery. LEVEL OF EVIDENCE: Level III.