{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T08:26:24Z","timestamp":1787300784092,"version":"build-2736575974"},"reference-count":28,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The significance of failing to achieve the minimum clinically important difference (MCID) early after surgery for degenerative cervical myelopathy (DCM) remains unclear. To compare postoperative clinical outcomes among early-, delayed-, and persistent non-responders for DCM and to clarify the clinical significance of delayed neurological recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 655 patients with moderate-to-severe DCM were categorized according to the achievement of the MCID in the Japanese Orthopaedic Association (JOA) score: early responders (MCID at 6 months), delayed responders (no MCID at 6 months but MCID at 2 years), and persistent non-responders (no MCID at either time point). Neurological, pain-related, and patient-reported outcomes were compared among the groups. Among patients without MCID achievement at 6 months, binary logistic regression analysis was performed to identify the factors associated with delayed MCID achievement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among patients without MCID achievement at 6 months, 36.9% achieved the MCID by 2 years. Binary logistic regression identified the 6-month JOA score, upper extremity function in the JOA Cervical Myelopathy Evaluation Questionnaire, and physical component summary of the 36-Item Short Form Health Survey as associated factors. Pain-related measures, autonomic function, and mental health status did not differ significantly among the groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately one-third of patients without early MCID achievement subsequently achieved the MCID within 2 years. Failure to achieve the MCID at 6 months does not necessarily indicate poor long-term outcomes, supporting the importance of continued postoperative follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261480021","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:04:26Z","timestamp":1786971866000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patterns of Neurological Recovery after Posterior Decompression Without Fusion for Degenerative Cervical Myelopathy According to the Timing of Minimum Clinically Important Difference Achievement"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0912-7422","authenticated-orcid":false,"given":"Toshiki","family":"Okubo","sequence":"first","affiliation":[{"name":"Keio University School of Medicine"},{"name":"Keio Spine Research Group 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