TY - JOUR
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.
N1 - Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
PY - 2019/11/1
Y1 - 2019/11/1
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.
KW - AOSpine
KW - Degenerative cervical myelopathy
KW - Myelopathy
KW - Outcomes
KW - Surgery
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U2 - 10.1093/neuros/nyz178
DO - 10.1093/neuros/nyz178
M3 - Article
C2 - 31144725
AN - SCOPUS:85070989250
SN - 0148-396X
VL - 85
SP - E917-E923
JO - Clinical Neurosurgery
JF - Clinical Neurosurgery
IS - 5
ER -