Rapid opening and closing of the hand as a measure of early neurologic recovery in the upper extremity after surgery for cervical spondylotic myelopathy

Objective: To compare the results of a simple bedside test with the Jebsen-Taylor hand function test, in the assessment of early improvement of neurologic function after surgery for cervical spondylotic rnyelopathy (CSM). Design: Case series comparing the bedside test with the Jebsen-Taylor test of hand function as the criterion standard in a blinded comparison. Setting: Referral center, institutional practice, hospitalized care. Participants: One hundred referent subjects and 26 consecutive patients undergoing surgery for CSM. Intervention: Decompressive cervical spine surgery. Main Outcome Measures: Complete, rapid opening and closing of the hand was timed for 20, 40, and 60 repetitions, the Rapid Hand Flick Time (RHFT), preoperatively and in the first week postoperatively. The results of this test were correlated with the Jebsen-Taylor test. Results: There was a 40% to 50% prolongation in the RHFT compared with age-matched referent subjects. Postoperatively, there was a 3.84-second mean improvement in the RHFT for 20 repetitions ill the right hand and 2.8 seconds in the left hand. A paired-samples t test, comparing the preoperative and postoperative day 1 and day 7 timings. showed a statistically significant improvement (P < .001). There was no significant change from postoperative day 1 to day 7. In the Jebsen-Taylor test, patients showed a significant postoperative improvement (P < .01) in the writing test, in simulated feeding. and in transfer of small objects in both hands. Pearson correlation coefficient testing for correlation between the RHFT and the Jebsen-Taylor subtests were low, which indicates that, although they both record an improvement after surgery, they probably do not test the same aspects of hand function. Conclusions: The RHFT is a simple and reliable method of assessing early improvement in hand function and spasticity in patients after surgery for CSM.