Predictors of Return to Normal Neurological Function after Surgery for Moderate and Severe Degenerative Cervical Myelopathy: An Analysis of A Global AOSpine Cohort of Patients

Rafael De La Garza Ramos, Aria Nouri, Jonathan Nakhla, Murray Echt, Yaroslav Gelfand, Smruti K. Patel, Rani Nasser, Joseph S. Cheng, Reza Yassari, Michael G. Fehlings

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE: To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS: This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS: A total of 51 patients (20.3%) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95% confidence interval [CI], 0.01-0.79; P =. 03) and longer walking time on the 30-m walking test (OR 0.95; 95% CI, 0.92-0.99; P =. 03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION: In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.

Original languageEnglish (US)
Pages (from-to)E917-E923
JournalClinical Neurosurgery
Volume85
Issue number5
DOIs
StatePublished - Nov 1 2019

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Spinal Cord Diseases
Walking
Orthopedics
Odds Ratio
Magnetic Resonance Imaging
Confidence Intervals
North America
Multicenter Studies
Area Under Curve
Counseling
Logistic Models
Regression Analysis
Prospective Studies
Safety

Keywords

  • AOSpine
  • Degenerative cervical myelopathy
  • Myelopathy
  • Outcomes
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Predictors of Return to Normal Neurological Function after Surgery for Moderate and Severe Degenerative Cervical Myelopathy : An Analysis of A Global AOSpine Cohort of Patients. / De La Garza Ramos, Rafael; Nouri, Aria; Nakhla, Jonathan; Echt, Murray; Gelfand, Yaroslav; Patel, Smruti K.; Nasser, Rani; Cheng, Joseph S.; Yassari, Reza; Fehlings, Michael G.

In: Clinical Neurosurgery, Vol. 85, No. 5, 01.11.2019, p. E917-E923.

Research output: Contribution to journalArticle

De La Garza Ramos, Rafael ; Nouri, Aria ; Nakhla, Jonathan ; Echt, Murray ; Gelfand, Yaroslav ; Patel, Smruti K. ; Nasser, Rani ; Cheng, Joseph S. ; Yassari, Reza ; Fehlings, Michael G. / Predictors of Return to Normal Neurological Function after Surgery for Moderate and Severe Degenerative Cervical Myelopathy : An Analysis of A Global AOSpine Cohort of Patients. In: Clinical Neurosurgery. 2019 ; Vol. 85, No. 5. pp. E917-E923.
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abstract = "BACKGROUND: Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE: To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS: This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS: A total of 51 patients (20.3{\%}) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95{\%} confidence interval [CI], 0.01-0.79; P =. 03) and longer walking time on the 30-m walking test (OR 0.95; 95{\%} CI, 0.92-0.99; P =. 03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION: In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.",
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T1 - Predictors of Return to Normal Neurological Function after Surgery for Moderate and Severe Degenerative Cervical Myelopathy

T2 - An Analysis of A Global AOSpine Cohort of Patients

AU - De La Garza Ramos, Rafael

AU - Nouri, Aria

AU - Nakhla, Jonathan

AU - Echt, Murray

AU - Gelfand, Yaroslav

AU - Patel, Smruti K.

AU - Nasser, Rani

AU - Cheng, Joseph S.

AU - Yassari, Reza

AU - Fehlings, Michael G.

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N2 - BACKGROUND: Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE: To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS: This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS: A total of 51 patients (20.3%) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95% confidence interval [CI], 0.01-0.79; P =. 03) and longer walking time on the 30-m walking test (OR 0.95; 95% CI, 0.92-0.99; P =. 03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION: In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.

AB - BACKGROUND: Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE: To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS: This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS: A total of 51 patients (20.3%) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95% confidence interval [CI], 0.01-0.79; P =. 03) and longer walking time on the 30-m walking test (OR 0.95; 95% CI, 0.92-0.99; P =. 03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION: In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.

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