The Impact of patient-reported Bladder Dysfunction on the Quality of Life of Patients With Degenerative Cervical Myelopathy.

OBJECTIVE: This study aimed to evaluate the prevalence of patient-reported bladder dysfunction in individuals with degenerative cervical myelopathy (DCM), its impact on quality of life (QOL), and postoperative bladder function and QOL improvements.

SUMMARY OF BACKGROUND DATA: DCM frequently causes bladder dysfunction, in addition to limb neurological deficits, which substantially impair QOL. Although it is well established that posterior decompression surgery improves neurological function, its effect on patient-reported bladder function remains unclear.

METHODS: We retrospectively analyzed prospectively collected data from 163 patients who underwent cervical laminoplasty for DCM during 2019-2021. Bladder dysfunction and QOL were assessed using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ), particularly its bladder dysfunction (CMEQ-BD) and QOL (CMEQ-QOL) domains. Patients with a preoperative CMEQ-BD score of <90 were considered to have bladder dysfunction. Postoperative improvement was defined as a >20-point increase or 2-year postoperative CMEQ-BD score of ≥90.

RESULTS: Preoperative patient-reported bladder dysfunction was identified in 123 of the 163 patients. Compared with patients without bladder dysfunction, those with bladder dysfunction were significantly older and had worse QOL. Multivariate analysis showed that bladder dysfunction was independently associated with lower preoperative QOL (β=-0.167, P=0.031). At postoperative 2 years, only 27 of the 123 patients (22.0%) experienced postoperative bladder function improvement. No demographic or clinical factors were significantly associated with postoperative bladder function recovery. However, patients with improved bladder function showed significantly greater improvements in neurological function (JOA score, P=0.007) and QOL (P<0.001) than those without improvement.

CONCLUSIONS: Patient-reported bladder dysfunction was highly prevalent in patients with DCM and was independently associated with impaired QOL. However, bladder dysfunction rarely improved postoperatively. These findings suggest that considering bladder dysfunction may be helpful when determining the optimal surgery timing in patients with DCM.

STUDY DESIGN: Retrospective cohort study.

LEVEL OF EVIDENCE: Level Ⅲ.