Determinants of quality of life in degenerative cervical myelopathy: a systematic review

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Validated HRQoL instruments and number of included papers which utilised them.

Quality of Life Instruments used in DCM Literature	Number of papers
SF-36 (PCS and MCS)	59
EQ-5D	10
SF-36 (PCS only)	7
SF-12	6
JOACMEQ	4
SF-6D	1
PHQ-9	1
WHOQOL-BREF	1

Table 2. Potential determinants of DCM HRQoL. Interpretation of the quality of evidence using the GRADE criteria is as follows: High quality (+ + + +) denotes further research is very unlikely to change our confidence in the estimate of effect. Moderate quality (+ + + −) denotes further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality (+ + − −) denotes further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality (+ − − −) denotes any estimate of effect is very uncertain.^103,104

Theme	Sub-theme	Relationship examined (HRQoL & X)	Total (significant, NS) Significant (+, -)	CEBM Level of Evidence	Conclusion (quality of evidence using the GRADE criteria)^30
1. Surgical management	Comparing pre- and post-operative	Postoperative HRQoL (PCS and MCS) compared to pre-operative HRQoL (PCS and MCS)	14 (11,3) → (^7^,^29–38, ^39–41) 11 (11, 0) → (^7^,^29–38, 0)	2B to 4	Significantly higher (+ + + −)
		Postoperative HRQoL (PCS only) compared to pre-operative HRQoL (PCS only)	5 (5,0) → (^82–86, 0) 5 (5,0) → (^82–86, 0)	2B	Significantly higher (+ + + +)
	Comparing surgery and conservative management	HRQoL following surgery compared to conservative management	1 (0,1) → (0,^42)	2B	No significant difference (+ − − −)
	Comparing two surgical techniques	HRQoL following different surgical approaches	15 (7,8) → (^14^,^43–48^,^83^, ^49–55)	1B to 4	Uncertain (+ + − −)
		Postoperative HRQoL following cervical microendoscopic laminotomy (CMEL) vs conventional expansive laminoplasty (ELAP)	2, (0,2) → (0,^53^,^55)	3B	No significant difference (+ − − −)
		Postoperative HRQoL following French door laminoplasty vs open-door laminoplasty	1 (1,0) →(^46, 0) 1 (1,0) →(^46, 0)	1B	Significantly higher after French door (+ − − −)
		Postoperative HRQoL following anterior vs posterior surgery	5 (4,1) →(^43–45^,^47^,^50) 4 (4, 0) →(^43–45^,^47, 0)	2B	Significantly higher after anterior approach (+ + − −)
		Postoperative HRQoL following anterior vs combined anterior and posterior approaches	1 (0,1) →(0,^49)	2B	No significant difference (+ − − −)
		Postoperative HRQoL following arthroplasty vs anterior discectomy and fusion	1 (1,0) →(^48, 0) 1 (1,0) →(^48, 0)	2B	Significantly higher in arthroplasty (+ − − −)
		Postoperative HRQoL following laminoplasty vs laminectomy and fusion	3 (0,3) →(0,^51^,^52^,^55)	2B to 3B	No significant difference (+ + − −)
		Postoperative HRQoL following Double-door Laminoplasty vs Selective Laminoplasty	1 (0,1) → (0,^54)	4	No significant difference (+ − − −)
2. Additional peri-operative management		HRQoL with and without additional peri-operative treatment	3 (0, 3) → (0,^87–89)	1B to 2B	No significant difference (+ − − −)
3. Patient experience after surgery	Satisfaction	Level of satisfaction and HRQoL (MCS and PCS)	1 (1,0) → (^90,0) 1 (1,0) → (^90,0)	2B to 4	Significant relationship (+ + − −)
		Level of satisfaction and HRQoL (PCS only)	2 (2, 0) → (^56^,^91,0) 2 (2, 0) → (^56^,^91,0)	2B	Significant Relationship (+ + − −)
	Pain	Level of pain and HRQoL	7 (5, 2) → (^40^,^57–60, ^61^,^92) 5 (0, 5) → (0, ^40^,^57–60)	2B to 4	Significant relationship (+ + + −)
	Postoperative complication	Postoperative complications and HRQoL	1 (0,1) → (0,^93)	2B	No significant relationship (+ − − −)
4. Cervical alignment, balance and range of motion	–	Structural spinal deformities and HRQoL (PCS only)	9 (7,2) → (^43^,^61–66^,^64^,^94) 7 (7,0) → (^43^,^61–66, 0)	2B to 4	Significant relationship (+ + + −)
5. Radiological characteristics of the spinal cord	Cord compression	Cord compression and HRQoL	2 (1, 1) → (^96^,^95) 1 (0,1) → (0,^96)	2B	Uncertain (+ − − −)
	Diffusion Tensor Imaging	Fractional anisotropy and HRQoL	1 (0,1) → (0,^68)	2B	No significant relationship (+ − − −)
6. Functional disability and severity of DCM		Disability due to DCM and HRQoL (PCS only)	5 (5,0) → (^56^,^69–72,0) 5 (0,5) → (0, ^56^,^69–72)	2B to 4	Significant relationship (+ + + −)
		Disability due to DCM and HRQoL (PCS and MCS)	4 (3,1) → (^14^,^73^,^74, ^97) 3 (0,3) → (0, ^14^,^73^,^74)	2B to 4	Significant relationship (+ + + −)
7. Demographics	Age	Age and HRQoL	3 (2, 2) → (^14^,^42, ^75^,^98) 2 (0,2) → (0, ^14^,^42)	2B	Uncertain (+ − − −)
	Race	Race and HRQoL	2 (1,1) →(^14^,^99)	2B	Uncertain (+ − − −)
	Geographic variation	Continent and HRQoL	2 (1,1) →(^100, ^7)	2B	Uncertain (+ + − −)
8. Co-morbidities		Presence of comorbidities and HRQoL	8 (7,1) → (^14^,^76–81, ^101) 7 (0,7) →(0, ^14^,^76–81)	2B	Significant relationship (+ + + −)
9. Biochemistry and molecular genetics	Polymorphism in brain derived neurotrophic factor (BDNF) gene	Val66Met and HRQoL	1 (1,0) →(^102, 0) 1 (0,1) →(0,^102)	2B	Significant relationship (+ − − −)

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