Abstract
Previous studies aimed at identifying predictors of clinical outcomes following surgical decompression for degenerative cervical myelopathy (DCM) are limited by multicollinearity among predictors, whereby the high degree of correlation between covariates precludes detection of potentially significant findings. We apply partial least squares (PLS), a data-driven approach, to model multi-dimensional variance and dissociate patient phenotypes associated with functional, disability, and quality of life (QOL) outcomes in DCM. This was a post-hoc analysis of DCM patients enrolled in the prospective, multi-center AOSpine CSM-NA/CSM-I studies. Baseline clinical covariates evaluated as predictors included demographic (e.g., age, sex), clinical presentation (e.g., signs and symptoms), and treatment (e.g., surgical approach) characteristics. Outcomes evaluated included change in functional status (∆mJOA), disability (∆NDI), and QOL (∆SF-36) at 2 years. PLS was used to derive latent variables (LVs) relating specific clinical covariates with specific outcomes. Statistical significance was estimated using bootstrapping. Four hundred and seventy-eight patients met eligibility criteria. PLS identified 3 significant LVs. LV1 indicated an association between presentation with hand muscle atrophy, treatment by an approach other than laminectomy alone, and greater improvement in physical health-related QOL outcomes (e.g., SF-36 Physical Component Summary). LV2 suggested the presence of comorbidities (respiratory, rheumatologic, psychological) was associated with lesser improvements in functional status post-operatively (i.e., mJOA score). Finally, LV3 reflected an association between more severe myelopathy presenting with gait impairment and poorer mental health-related QOL outcomes (e.g., SF-36 Mental Component Summary). Using PLS, this analysis uncovered several novel insights pertaining to patients undergoing surgical decompression for DCM that warrant further investigation: (1) comorbid status and frailty heavily impact functional outcome; (2) presentation with hand muscle atrophy is associated with better physical QOL outcomes; and (3) more severe myelopathy with gait impairment is associated with poorer mental QOL outcomes.
Highlights
These people become clinically symptomatic from mechanical spinal cord c ompression[5]
As the global population continues to a ge[6], optimizing the diagnosis and treatment of degenerative cervical myelopathy (DCM) are key public health priorities
Pine CSM North A merica[1] (CSM-NA; ClinicialTrials.gov NCT00285337) and AOSpine CSM International[12] (CSM-I; ClinicalTrials.gov NCT00565734) studies. These were single-armed, prospective, multi-center cohort studies conducted at 26 global sites that aimed to evaluate the efficacy of surgical decompression in patients with DCM with regard to functional status, disability, and quality-of-life (QOL) outcomes
Summary
These people become clinically symptomatic from mechanical spinal cord c ompression[5]. There is a critical need to parse out this heterogeneity and identify factors associated with clinical improvement or worsening post-operatively. This would inform patient counselling and calibration of expectations, as well as facilitate selection of good surgical candidates. Partial least squares (PLS) circumvents this limitation of traditional statistical m odels[10] This mathematical approach is well suited to facilitate understanding of the interrelations among multi-dimensional data. We apply PLS to dissociate phenotypes, defined by weighted combinations of demographic, disease, and treatment characteristics, associated with functional status, disability, and QOL outcomes in patients undergoing surgical decompression for DCM
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