159. Efficacy of surgical decompression in patients with cervical spondylotic myelopathy results of the Canadian prospective multicenter study

Abstract

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment worldwide. Recent evidence suggests that patients with CSM benefit from surgical intervention regardless of their preoperative disease severity. PURPOSE The goals of this study are (1) to validate previous results and (2) to assess the impact of surgery on neurologic and health-related quality of life (HRQoL) outcome measures at 12 months after surgery in a prospective cohort of patients. STUDY DESIGN/SETTING In this multicenter, prospective cohort study, patients were recruited by 35 surgeons from seven Canadian centers between 2015 and 2018. PATIENT SAMPLE Eligible patients had a clinical diagnosis of CSM with evidence of spinal cord compression and had completed at least 12 months of follow-up. OUTCOME MEASURES Outcome measures included the modified Japanese Orthopaedic Association (mJOA) score, neck disability index (NDI), EQ-5D and SF-12. These were assessed at baseline and at 12 months after surgery for the whole cohort and were further analyzed based on pre-operative disease severity: mild (mJOA ≥15), moderate (mJOA 12 – 14), and severe (mJOA METHODS N/A RESULTS Of 378 patients who underwent surgical decompression, disease severity and outcomes measures at 12 months were available for 364. Mean age is 59 years, and females comprise 37% of the cohort. A total of 104 patients (29%) were classified as having mild myelopathy, 153 (42%) as moderate, and 107 severe (29%). At baseline, patients with severe myelopathy were older, were more disabled, and had lower HRQoL scores. For the whole cohort, there was significant improvement in all outcome measures at 12 months (p CONCLUSIONS This study validates the results of previous studies that demonstrated improved outcomes with surgical decompression in cervical myelopathy. When stratified by disease severity, however, patients with mild myelopathy did not improve significantly from an mJOA or HRQoL perspective compared to patients with moderate and severe disease. These findings highlight the controversy of how to manage a patient with mild cervical myelopathy and support a more conservative approach with close clinical follow-up in neurologically stable patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.