Quality of Life Assessment with the Medical Outcomes Study Short Form-36 Among Patients with Cervical Spondylotic Myelopathy

Objective: Cervical spondylotic myelopathy (CSM) is a chronic degenerative condition of the cervical spine that produces narrowing of the spinal canal and disruption of spinal cord function. We used Medical Outcomes Study Short Form-36 (SF-36), a generic quality of life outcome-assessment instrument, to assess the quality of life among patients with CSM.

Methods: A cohort of 88 Veterans Administration neurosurgery clinic patients with CSM underwent structured interviews for collection of data on demographic features, symptoms, operations, and comorbid diseases. Patients also completed the SF-36. Symptoms and examination findings were used to assign each patient scores on the Nurick, Cooper, and Harsh myelopathy scales and a Western modification of the Japanese Orthopaedic Association scale. SF-36 scores were compared with age-adjusted Veterans Administration population normative values by using Student's t test with unequal variances. Cuzick's nonparametric test for trend was used to explore the relationship between the SF-36 physical component summary scores and the myelopathy scale scores.

Results: Patients with CSM exhibited decreased quality of life in all eight SF-36 domains, as well as with the physical and mental component summary scores, compared with Veterans Administration population normative values (for all, P </= 0.003). Lower physical component summary scores were associated with worse myelopathy scores on the Nurick scale (P < 0.001), Cooper leg subscale (P = 0.012), and Harsh scale (P < 0.001).

Conclusion: Patients with CSM exhibit decreased quality of life in all health domains assessed with the SF-36, a generic health outcome-measurement instrument. The impairments of patients with CSM extend beyond the motor, sensory, and bladder dysfunctions recorded with myelopathy scales, into the realms of emotional and mental health.