Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results of the AOSpine North America Prospective Multi-Center Study

Details

• Personal Author:
  Arnold PM ; Banco RJ ; Bono CM ; Brodke DS ; Chapman JR ; Dekutoski MB ; Fehlings MG ; Gokaslan ZL ; Janssen ME ; Kopjar B ; Massicotte EM ; Sasso RC ; Shaffrey CI ; Smith JS ; Vaccaro AR ; Wilson JR ; Woodard EJ ; Yoon ST
• Description:
  Background: Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction worldwide. The objective of this study was to evaluate the impact of surgical decompression on functional, quality-of-life, and disability outcomes at one year after surgery in a large cohort of patients with this condition. Methods: Adult patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression were enrolled at twelve North American centers from 2005 to 2007. At enrollment, the myelopathy was categorized as mild (modified Japanese Orthopaedic Association [mJOA] score = 15), moderate (mJOA = 12 to 14), or severe (mJOA < 12). Patients were followed prospectively for one year, at which point the outcomes of interest included the mJOA score, Nurick grade, Neck Disability Index (NDI), and Short Form-36 version 2 (SF-36v2). All outcomes at one year were compared with the preoperative values with use of univariate paired statistics. Outcomes were also compared among the severity classes with use of one-way analysis of variance. Finally, a multivariate analysis that adjusted for baseline differences among the severity groups was performed. Treatment-related complication data were collected and the overall complication rate was calculated. Results: Eighty-five (30.6%) of the 278 enrolled patients had mild cervical spondylotic myelopathy, 110 (39.6%) had moderate disease, and 83 (29.9%) had severe disease preoperatively. One-year follow-up data were available for 222 (85.4%) of 260 patients. There was a significant improvement from baseline to one year postoperatively (p < 0.05) in the mJOA score, Nurick grade, NDI score, and all SF-36v2 health dimensions (including the mental and physical health composite scores) except general health. With the exception of the change in the mJOA, the degree of improvement did not depend on the severity of the preoperative symptoms. These results remained unchanged after adjusting for relevant confounders in the multivariate analysis. Fifty-two patients experienced complications (prevalence, 18.7%), with no significant differences among the severity groups. Conclusions: Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories. Furthermore, complication rates observed in the study were commensurate with those in previously reported cervical spondylotic myelopathy series. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Musculoskeletal Diseases Musculoskeletal System Occupational Health Safety
• Keywords:
  Author Keywords: Surgery Cervical Spondylotic Myelopathy Cohort Studies CSM Medical Treatment Multicenter Trial Neck Injuries Spinal Cord Disorders Surgery Surgical Outcomes
• ISSN:
  0021-9355
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Colorado ; Georgia ; Indiana ; Kansas ; Maryland ; Massachusetts ; Minnesota ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; Pennsylvania ; Utah ; Virginia ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  95
• Issue:
  18
• NIOSHTIC Number:
  nn:20056416
• Citation:
  J Bone Jt Surg 2013 Sep; 95(18):1651-1658
• Contact Point Address:
  Michael G. Fehlings, MD, PhD, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, West Wing, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
• Email:
  Michael.Fehlings@uhn.on.ca
• Federal Fiscal Year:
  2013
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Journal of Bone and Joint Surgery
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:5b689bbfea5d5b050457980bb3a18f828690803a8e1350741c46708a29ee61c3c545e8fe05689c9ccb9adb69631d761b2521467c4ad44f2d61a649e8d2c9556b
• Download URL:
  https://stacks.cdc.gov/view/cdc/214024/cdc_214024_DS1.pdf
• File Type:
  [PDF - 521.88 KB ]