Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy

Fehlings, Michael G.; Wilson, Jefferson R.; Kopjar, Branko; Yoon, S. Tim; Arnold, Paul M.; Massicotte, Eric M.; Vaccaro, Alexander R.; Brodke, Darrel S.; Shaffrey, Christopher I.; Smith, Justin S.; Woodard, Eric J.; Banco, Robert; Chapman, Jens R.; Janssen, Michael; Bono, Christopher M.; Sasso, Rick C.; Dekutoski, Mark B.; Gokaslan, Ziya L.

doi:10.2106/jbjs.l.00589

Cited by 428 publications

(330 citation statements)

References 25 publications

Supporting

Mentioning

311

Contrasting

Unclassified

Order By: Relevance

“…8 In our study, 610 patients (88.79%) either stayed the same or improved, while 77 patients (11.21%) deteriorated based on mJOA scale scores. The MCID is a metric that describes a change in status that a patient would define as meaningful.…”

Section: Discussionmentioning

confidence: 47%

“…5,8 In general, surgical decompression of the cervical spine is effective at halting neurological deterioration, relieving certain symptoms, and improving functional status and quality of life. The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial.…”

mentioning

confidence: 99%

“…3,19,20 Based on two recent prospective studies, patients, on average, exhibited a 2.40-to 2.88-point gain on the modified Japanese Orthopaedic Association (mJOA) scale following surgery, an improvement exceeding the overall MCID for this metric (2 points). 2,5,8,28 The MCID of the mJOA scale, however, varies based on preoperative myelopathy severity: 1 point for mild myelopathy (mJOA ≥ 15), 2 points for moderate myelopathy (mJOA score of [12][13][14], and 3 points for severe disease (mJOA score < 12). 28 Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements in functional status.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Tetreault

Wilson

Kotter

et al. 2016

FOC

Self Cite

View full text Add to dashboard Cite

OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower-limb spasticity, and broad-based unstable gait. The final model included age (relative risk [RR] 0.924, p < 0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS In this large multinational prospective cohort, 70% of patients treated surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The key predictors of achieving an MCID on the mJOA scale were younger age, shorter duration of symptoms, nonsmoking status, and lack of significant gait impairment.

show abstract

Section: Discussionmentioning

confidence: 47%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Tetreault

Wilson

Kotter

et al. 2016

FOC

Self Cite

View full text Add to dashboard Cite

show abstract

“…The use of the posterior and anterior approaches varied in the literature. Fehlings et al presented the results of 278 patients in the AO Spine North America prospective multicenter study and showed that anterior surgery was predominant in patients with mild (76.5%), moderate (61.8%), and severe (43.5%) conditions, ; however, it became inferior to posterior surgery (45.8%) in patients with severe CSM 9) . A Chinese study found posterior (76) and combined (58) surgeries were more common than anterior (19) surgery for 153 consecutive patients with multilevel CSM 10) .…”

Section: Discussionmentioning

confidence: 99%

“…Radiculopathy including C5 palsy, wound infection, hardware failure, and hematoma occurred following posterior surgeries 10,[20][21][22] . There were few reports that described general complications in CSM surgeries 9,19,23) , and there has not been a report that described the associations between general complications and surgical variables and preoperative conditions, including comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Surgical and general complications in 2,961 Japanese patients with cervical spondylotic myelopathy: Comparison of different age groups

Imajo

Taguchi

Neo

et al. 2017

Spine Surg Relat Res

View full text Add to dashboard Cite

Abstract:Introduction: Details of surgical and general complications for patients with cervical spondylotic myelopathy (CSM) are still uncertain. The purpose of this study was to describe surgeries and their complications among Japanese patients with CSM. Methods: The Japanese Society for Spine Surgery and Related Research performed a nationwide survey on spine surgery and complications in 2011. Data of patients with 2,961 CSM >40 years old were included. The clinicopathological variables were basic demographic and clinical information, surgical information, and surgical and general complications. To examine the influence of age, variables were compared among three age groups: patients 40-64 (n=1,123), 65-74 (n=966), and ! 75 (n=872) years of age. Results: The study included 1,970 males and 991 females and the mean age was 64.3 years old. There were 168 anterior (5.7%) and 2,770 posterior (94.2%) approach surgeries. The vast majority of patients with CSM were treated using the posterior approach, 89.4% of whom had decompression surgery only. Anterior surgeries were more common in the younger age group, but posterior surgeries were equally distributed. The incidence of total complications including surgical/general complications was similar for the anterior (16/168; 9.5%) and posterior (295/2,770; 10.6%) approaches. No patient died on the operating table, but four patients (0.1%) died within one month after surgery. No association was detected between complications and age, comorbidity, and other surgical factors. The incidence of complications was similar for the different age groups. However general complications were predominantly observed in the older group and those who had instrumented surgery. Conclusions: The results indicate that the indication and surgical performance for patients with CSM is favorable in Japan, despite the super-aging population. Few serious complications were reported in this study. However, more detailed informed consent about surgical and, in particular, general complications is necessary for the older patients with CSM.

show abstract

Posterior surgical approach procedures for cervical myelopathy

Pohl¹,

Tamaoki

Rodrigues³

et al. 2015

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Part of the Orthopedics Commons This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Department of Orthopaedic Surgery Faculty Papers by an authorized administrator of the Jefferson Digital Commons.

show abstract

Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy

Cited by 428 publications

References 25 publications

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

Surgical and general complications in 2,961 Japanese patients with cervical spondylotic myelopathy: Comparison of different age groups

Posterior surgical approach procedures for cervical myelopathy

Contact Info

Product

Resources

About