Diagnosis Of Degenerative Cervical Myelopathy Research Articles

Updates in current concepts in degenerative cervical myelopathy: a systematic review.

The incidence of degenerative cervical myelopathy (DCM) has increased over the years due to an increasing aging population, yet there is a dearth of recent comprehensive data evaluating the multiple facets of this degenerative condition. Recent publications have highlighted the biochemistry and biomechanics of DCM, which are paramount to understanding the degenerative nature of the condition and selecting the most optimal treatment options for improved patient outcomes. In addition, there have been recent studies establishing the superiority of surgical to non-surgical treatments for DCM, which until now was a poorly substantiated claim that has permeated the medical field for decades. The authors of this systematic review sought to collect and assess available high quality peer reviewed data to analyze the nature of DCM and gain a better understanding for its treatment choices. PubMed and Cochrane Central Register of Controlled Trials were systematically searched on January 19, 2023 with date restrictions of 2015-2023 imposed. For initial data collection, five independent searches were completed using the following keywords: pathogenesis, pathophysiology, and epidemiology of DCM; cervical spondylotic myelopathy (CSM) and DCM recent developments; management and treatment for CSM and DCM; diagnosis and management of DCM; and pathophysiology of DCM. The results were screened for their application to DCM; any study that did not directly address DCM were identified and removed through abstract assessment, such studies included those pertaining to alternative fields including cardiology and psychiatry. Studies found relevant through full-text assessment and those published in English were included in this study and unpublished studies and studies found irrelevant based on titles and keywords were excluded from this study. The 115 articles that met criteria were critically appraised independently by the 2 reviewers and the principles of Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) were applied to assess the quality of evidence from each study. A total of 352 studies resulted from the original search. There were 71 duplicate articles that were removed and a total of 281 articles were screened. 166 articles were then removed based on the exclusion/inclusion criteria, title, and abstract. Of the 138 articles that remained, a final list of 115 articles was created based on the reporting measures. DCM is a multifactorial disease that has the potential to impair neurological function and cause significant paralysis. Although the multiple facets of this disease have not been fully elucidated, there have been significant breakthroughs in understanding the mechanisms involved in this disease process. The use of complex imaging modalities, genetic sequencing, biomarkers, and pharmacological agents has provided insight into the factors involved in the progression of DCM, which has consequently cultivated more refined approaches for diagnosis and treatment of DCM.

Efficacy of Dynamic Magnetic Resonance Imaging in the Diagnosis of Degenerative Cervical Myelopathy: Systematic Review Protocol.

Cervical degenerative myelopathy (CDM) is a cervical spine condition resulting in clinical manifestations of spinal cord compression related to the chronic, non-traumatic, and progressive narrowing of the cervical spinal canal. Conventional magnetic resonance imaging (MRI) is the gold standard test to diagnose and assess the severity of CDM. However, the patient is in a neutral and static position during the MRI scan, which may devalue the dynamic factors of CDM, underestimating the risk of spinal cord injury related to cervical spine flexion and extension movements. Dynamic MRI is a promising technique to change this scenario. Therefore, the present review aims to answer the following question: "Is dynamic MRI of the cervical spine more accurate in diagnosing CDM than conventional MRI?". We will search for studies in the MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS, and SciELO databases. The search strategy will contain a combination of terms related to cervical myelopathy and magnetic resonance imaging . Two independent reviewers will select studies, extract data, and assess the risk of bias. The synthesis of results will be descriptive, considering the main findings of the studies about the outcomes of interest.

Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy

IntroductionPeople with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research questionDoes the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possible DCM? Materials and methodsThis is a prospective study of consecutive adult patients, referred to a National Neurosurgical Centre with a neck problem. Assessing clinicians undertook standard clinical examination and calculated the mJOA score. A consultant radiologist independently reported radiological findings, after which the assessing clinician determined the diagnosis. The sensitivity and specificity of mJOA for DCM at various cut-points was statistically analysed using Receiver Operating Characteristics (ROC) curves. ResultsOf 201 patients (98 male, mean age 52.6 ± 13y) assessed over 13 months, 21 were diagnosed with DCM (prevalence 10.4%). Fifteen (71.4%) had a mJOA score classifying disease severity as mild, 4/21 (19%) had moderate disease and two (9.5%) had severe disease. A mJOA score ≤17 (cutpoint ≥1) showed sensitivity of 95% and specificity of 71% for the clinical diagnosis of DCM. mJOA score ≤16 (cutpoint ≥2) had sensitivity of 62% and specificity of 90%. The ROC area under the curve was 0.885 (95% confidence interval: 0.82 to 0.95). 87% of patients were correctly classified. Discussion and conclusionmJOA score ≤16 is 90% specific for a subsequent diagnosis of DCM in people with neck problems and has potential to be used as an early detection tool. Further research is needed to replicate these findings and establish feasibility and acceptability in primary care.

The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy - A Systematic review and Meta-analysis.

Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for DCM will likely facilitate earlier referral for definitive management. This systematic review aims to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in DCM? A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing DCM. Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. The QUADAS-2 tool was used to evaluate the risk of bias of individual studies. This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. An additional 61 articles reported on the frequency of clinical signs in a cohort of DCM patients. The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. Five studies evaluated the association between the presence of various clinical signs and disease severity. There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity. The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM.

The Value of Clinical Tests in the Diagnosis of Degenerative Cervical Myelopathy: Results of a Systematic Review (P7-4.001)

The Value of Clinical Tests in the Diagnosis of Degenerative Cervical Myelopathy: Results of a Systematic Review (P7-4.001)

The Frequency of Symptoms in Patients with a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review (P5-4.007)

The Frequency of Symptoms in Patients with a Diagnosis of Degenerative Cervical Myelopathy: Results of a Scoping Review (P5-4.007)

A Diagnostic Biomarker for Cervical Myelopathy Based on Dynamic Magnetic Resonance Imaging.

Multicenter prospective observational study. Diffusion tensor imaging in flexion extension improves the diagnosis of degenerative cervical myelopathy (DCM). We aimed to provide an imaging biomarker for the detection of DCM. DCM is the most common form of spinal cord dysfunction in adults; however, imaging surveillance for myelopathy remains poorly characterized. Symptomatic DCM patients were examined in maximum neck flexion-extension and neutral positions in a 3T-magnetic resonance imaging scanner and allocated to 2 groups: (1) Patients with visible intramedullary hyperintensity (IHIS) on T2-weighted imaging (IHIS+, n = 10); and (2) Patients without IHIS (IHIS-, n = 11). Range of motion, space available for the spinal cord, apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity, and fractional anisotropy were measured and compared between the neck positions and between the groups as well as between control (C2/3) and pathologic segments. Significant differences between the control level (C2/3) and pathologic segments were appreciated for the IHIS+ group at neutral neck position in AD; at flexion in ADC and AD; and at neck extension in ADC, AD, and fractional anisotropy values. For the IHIS- group, significant differences between the control level (C2/3) and pathologic segments were found only for ADC values in neck extension. When comparing diffusion parameters between groups, radial diffusivity was significantly different in all 3 neck positions. Significant increases in ADC values between the control and pathologic segments were found for both groups in neck extension only. This may serve as a diagnostic tool to identify early changes in the spinal cord related to myelopathy to indicate potentially reversible spinal cord injury and support the indication for surgery in select circumstances.

Degenerative cervical myelopathy: Where have we been? Where are we now? Where are we going?

Degenerative cervical myelopathy (DCM), a recently coined term, encompasses a group of age-related and genetically associated pathologies that affect the cervical spine, including cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament (OPLL). Given the significant contribution of DCM to global disease and disability, there are worldwide efforts to promote research and innovation in this area. An AO Spine effort termed 'RECODE-DCM' was initiated to create an international multistakeholder consensus group, involving patients, caregivers, physicians and researchers, to focus on launching actionable discourse on DCM. In order to improve the management, treatment and results for DCM, the RECODE-DCM consensus group recently identified ten priority areas for translational research.The current article summarizes recent advancements in the field of DCM. We first discuss the comprehensive definition recently refined by the RECODE-DCM group, including steps taken to arrive at this definition and the supporting rationale. We then provide an overview of the recent advancements in our understanding of the pathophysiology of DCM and modalities to clinically assess and diagnose DCM. A focus will be set on advanced imaging techniques that may offer the opportunity to improve characterization and diagnosis of DCM. A summary of treatment modalities, including surgical and nonoperative options, is then provided along with future neuroprotective and neuroregenerative strategies. This review concludes with final remarks pertaining to the genetics involved in DCM and the opportunity to leverage this knowledge toward a personalized medicine approach.

The role of dynamic MRI of the cervical spine and dynamic evoked potentials in the diagnosis of degenerative cervical myelopathy

The role of dynamic MRI of the cervical spine and dynamic evoked potentials in the diagnosis of degenerative cervical myelopathy

Electrodiagnostic Studies in Degenerative Cervical Myelopathy.

The diagnosis of degenerative cervical myelopathy can generally be made with a thorough history, physical examination, and spinal imaging. Electrodiagnostic studies, consisting of nerve conduction studies and electromyography, are a useful adjunct when the clinical picture is inconsistent or there is concern for overlapping pathology. Electrodiagnostic studies may be particularly helpful in identifying cases of myeloradiculopathy, when there is combined nerve root and spinal cord injury, both with regards to prognosis and guiding surgical treatment. Electrodiagnostic studies are a useful adjunct for the spine surgeon and should be used when there are features atypical for degenerative cervical myelopathy or when there is suspicion for a concomitant disease process.

Classification of expert-level therapeutic decisions for degenerative cervical myelopathy using ensemble machine learning algorithms.

BackgroundTherapeutic decisions for degenerative cervical myelopathy (DCM) are complex and should consider various factors. We aimed to develop machine learning (ML) models for classifying expert-level therapeutic decisions in patients with DCM.MethodsThis retrospective cross-sectional study included patients diagnosed with DCM, and the diagnosis of DCM was confirmed clinically and radiologically. The target outcomes were defined as conservative treatment, anterior surgical approaches (ASA), and posterior surgical approaches (PSA). We performed the following classifications using ML algorithms: multiclass, one-versus-rest, and one-versus-one. Two ensemble ML algorithms were used: random forest (RF) and extreme gradient boosting (XGB). The area under the receiver operating characteristic curve (AUC-ROC) was the primary metric. We also identified the variable importance for each classification.ResultsIn total, 304 patients were included (109 conservative, 66 ASA, 125 PSA, and 4 combined surgeries). For multiclass classification, the AUC-ROC of RF and XGB models were 0.91 and 0.92, respectively. In addition, ML models showed AUC-ROC values of >0.9 for all types of binary classifications. Variable importance analysis revealed that the modified Japanese Orthopaedic Association score and central motor conduction time were the two most important variables for distinguishing between conservative and surgical treatments. When classifying ASA and PSA, the number of involved levels, age, and body mass index were important contributing factors.ConclusionML-based classification of DCM therapeutic options is valid and feasible. This study can be a basis for establishing generalizable ML-based surgical decision models for DCM. Further studies are needed with a large multicenter database.

Development of a Novel Diagnostic Support Tool for Degenerative Cervical Myelopathy Combining 10-s Grip and Release Test and Grip Strength: A Pilot Study

Early diagnosis of degenerative cervical myelopathy (DCM) is desirable, as delayed treatment can cause irreversible spinal cord injury and subsequent activity of daily living (ADL) impairment. We attempted to develop a straightforward and accurate diagnostic tool for DCM by combining the grip and release test (GRT) and grip strength. As a pilot study, we measured the GRT and grip strength of patients with DCM (n = 247) and a control group (n = 721). Receiver operating characteristic analysis was performed using the lower left and right. The Youden index was used to set cutoff values by sex and age group. The diagnostic performance of each test varied by sex and age, and a diagnostic support tool was created to determine any abnormal results in a test. The calculated M/F cutoff values for GRT were as follows: 40–59 years, 21/18; 60–69 years, 17/17; 70–79 years, 15/15; and 80–89 years, 11/12. The calculated M/F cutoff values for grip strength 32/20, 29/13, 21/15, and 19/10. When either GRT or grip strength was judged as positive, the overall sensitivity was 88.2%, specificity was 78.1%, positive likelihood ratio was 4.03, and the negative likelihood ratio was 0.15. This novel diagnostic support tool was superior to using GRT and grip strength alone in the early DCM diagnosis. Future research to obtain age- and sex-specific data is necessary to validate and further improve the tool.

121. The influence of frailty in spine surgery populations is highly variable: an analysis of 57,027 patients from the NSQIP database undergoing surgery for degenerative cervical myelopathy or lumbar spondylolisthesis

<h3>BACKGROUND CONTEXT</h3> Frailty is an emerging concept in risk prediction for spine surgery, but how the influence of frailty affects different populations of patients with different index pathologies has not been established. <h3>PURPOSE</h3> To compare the effect of frailty in predicting 30-day outcomes after surgery in two common patient populations: degenerative cervical myelopathy (DCM) and degenerative spondylolisthesis (DS). <h3>STUDY DESIGN/SETTING</h3> Statistical analysis of prospectively-collected registry data. <h3>PATIENT SAMPLE</h3> Patients included in the National Safety and Quality Improvement (NSQIP) database 2010-2018 undergoing a surgical procedure with a diagnosis of DCM or DS. <h3>OUTCOME MEASURES</h3> (1) Major complication (pneumonia, deep vein thrombosis (DVT), pulmonary embolism, myocardial infarction, cardiac arrest, wound infection or dehiscence, stroke, and sepsis) within 30 days, and (2) mortality, reoperation, readmission within 30 days, length of stay and discharge destination. <h3>METHODS</h3> Patients with a diagnosis of DCM or DS undergoing surgery were selected from an assimilated database of the NSQIP registry in the years 2010-2018 inclusive using the corresponding ICD-9/-10 codes. The 5-point modified frailty index (MFI-5) was then calculated for all patients using a score of 0 (Not-Frail), 1 (Pre-Frail) 2 (Frail) or 3 or more (Severely Frail). Simple demographics, including age, type of approach, number of levels, co-morbidities, fusion or nonfusion surgery and frailty distribution were compared using descriptive statistics for parametric and nonparametric data. Univariate analysis was used to define the odds ratio (OR) or beta coefficient (BC, continuous variables) of major complication, mortality, readmission, reoperation, length of hospital stay and discharge destination stratified by frailty, and then compared between DCM and DS cohorts. A multivariable model adjusting for age, gender and frailty was then used to test any significant effect seen. <h3>RESULTS</h3> A total of 41,369 patients underwent surgery for DCM compared to 15,658 patients who underwent surgery for DS. DCM patients (mean age 56.6[56.5-56.7]) were younger than DS patients (mean age 62.5[62.31-69.70]; p <0.001). In the DCM group, 80% underwent anterior approach, 17% posterior and 3% combined. In the DS group, 27.7% underwent posterior decompression alone compared to 72.3% with instrumented fusion. The DCM group had a higher proportion of non-frail patients (45%) compared to the DS group (36.8%), and the distribution of frailty was significantly different between cohorts (p <0.001). OR of a major complication was greater in the DCM patients compared to DS patients, for all strata of frailty (2.40[2.06-2.80] vs 1.75[1.38-2.24] for pre-frail, 3.80[3.22-4.48] vs 2.02[1.50-2.69] for frail, and 11.63[9.44-14.33] vs 2.68[1.51-4.75] for severely frail patients; p <0.001 for each). Frailty demonstrated a larger effect on the mortality in DCM patients compared to DS patients (OR for pre-frail 4.89[2.72-8.79] vs 5.34[1.21-23.69], OR for severely frail 27.70[14.29-53.69] vs 9.15[0.83-101.20]). This was also true for length of hospital stay and discharge to non-home destination. The effect of frailty on reoperation or readmission was equivalent. On multivariable analysis, DCM patients demonstrated significantly greater OR of major complication (1.35[1.20-1.52]; p <0.001), mortality (3.02[1.89-4.83] but a shorter length of hospital stay (BC -0.33[-0.42 - -0.24]; p <0.001). <h3>CONCLUSIONS</h3> This study shows the influence of frailty amongst patients undergoing surgery for DCM and DS populations is not equivalent. In DCM populations, frailty has a greater effect size for metrics such as major complication or mortality compared to DS patients, but the opposite is true for length of hospital stay. Further work is required to define the key elements of frailty assessment in these discrete populations. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Application of electrophysiological measures in degenerative cervical myelopathy.

Degenerative cervical myelopathy (DCM) is one of the leading causes of progressive spinal cord dysfunction in the elderly. Early diagnosis and treatment of DCM are essential to avoid permanent disability. The pathophysiology of DCM includes chronic ischemia, destruction of the blood–spinal cord barrier, demyelination, and neuronal apoptosis. Electrophysiological studies including electromyography (EMG), nerve conduction study (NCS), motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) are useful in detecting the presymptomatic pathological changes of the spinal cord, and thus supplementing the early clinical and radiographic examinations in the management of DCM. Preoperatively, they are helpful in detecting DCM and ruling out other diseases, assessing the spinal cord compression level and severity, predicting short- and long-term prognosis, and thus deciding the treatment methods. Intra- and postoperatively, they are also useful in monitoring neurological function change during surgeries and disease progression during follow-up rehabilitation. Here, we reviewed articles from 1979 to 2021, and tried to provide a comprehensive, evidence-based review of electrophysiological examinations in DCM. With this review, we aim to equip spinal surgeons with the basic knowledge to diagnosis and treat DCM using ancillary electrophysiological tests.

Proposing a Framework to Understand the Role of Imaging in Degenerative Cervical Myelopathy: Enhancement of MRI Protocols Needed for Accurate Diagnosis and Evaluation.

Proposing a Framework to Understand the Role of Imaging in Degenerative Cervical Myelopathy: Enhancement of MRI Protocols Needed for Accurate Diagnosis and Evaluation.

Degenerative cervical myelopathy

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Its prevalence is increasing as a result of population aging. The diagnosis of DCM is often delayed or overlooked, resulting in secondary neurologic morbidity. The natural course of DCM typically presents as a gradual neurological deterioration, with symptoms ranging from muscle weakness to complete paralysis, with variable degrees of sensory deficits and sphincter dysfunction. Magnetic resonance imaging (MRI) and electrophysiological studies allow the assessment of spinal cord function and its structural damage to determine treatment and clinical outcomes. All patients with signs and symptoms consistent with DCM should be referred to a spine surgeon for assessment and tailored treatment. Those patients with mild DCM can be managed non-operatively but require close monitoring and education about potentially alarming signs and symptoms. Surgery is not currently recommended for asymptomatic patients with evidence of spinal cord compression or cervical spinal stenosis on MRI, but they require a structured follow-up. Patients with moderate or severe DCM require surgical decompression to avoid further progression. The objective of this review is to raise awareness of degenerative cervical myelopathy and its increasing prevalence as well as to aid non-surgical healthcare workers for a timely diagnosis and management of this disabling condition.

Establishing Diagnostic Criteria for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 3

Study Design:Narrative review.Objectives:To discuss the importance of establishing diagnostic criteria in Degenerative Cervical Myelopathy (DCM), including factors that must be taken into account and challenges that must be overcome in this process.Methods:Literature review summarising current evidence of establishing diagnostic criteria for DCM.Results:Degenerative Cervical Myelopathy (DCM) is characterised by a degenerative process of the cervical spine resulting in chronic spinal cord dysfunction and subsequent neurological disability. Diagnostic delays lead to progressive neurological decline with associated reduction in quality of life for patients. Surgical decompression may halt neurologic worsening and, in many cases, improves function. Therefore, making a prompt diagnosis of DCM in order to facilitate early surgical intervention is a clinical priority in DCM.Conclusion:There are often extensive delays in the diagnosis of DCM. Presently, no single set of diagnostic criteria exists for DCM, making it challenging for clinicians to make the diagnosis. Earlier diagnosis and subsequent specialist referral could lead to improved patient outcomes using existing treatment modalities.

The associations between radiological and neurological findings of degenerative cervical myelopathy: radiological analysis based on kinematic CT myelography and evoked potentials of the spinal cord.

Neurological and imaging findings play significant roles in the diagnosis of degenerative cervical myelopathy (DCM). Consistency between neurological and imaging findings is important for diagnosing DCM. The reasons why neurological findings exhibit varying sensitivity for DCM and their associations with radiological findings are unclear. This study aimed to identify associations between radiological parameters and neurological findings in DCM and elucidate the utility of concordance between imaging and neurological findings for diagnosing DCM. One hundred twenty-one patients with DCM were enrolled. The Japanese Orthopaedic Association (JOA) score, radiological parameters, MRI and kinematic CT myelography (CTM) parameters, and the affected spinal level (according to multimodal spinal cord evoked potential examinations) were assessed. Kinematic CTM was conducted with neutral positioning or at maximal extension or flexion of the cervical spine. The cross-sectional area (CSA) of the spinal cord, dynamic change in the CSA, C2-7 range of motion, and C2-7 angle were measured. The associations between radiological parameters and hyperreflexia, the Hoffmann reflex, the Babinski sign, and positional sense were analyzed via multiple logistic regression analysis. In univariate analyses, the upper- and lower-limb JOA scores were found to be significantly associated with a positive Hoffmann reflex and a positive Babinski sign, respectively. In the multivariate analysis, a positive Hoffmann reflex was associated with a higher MRI grade (p = 0.026, OR 2.23) and a responsible level other than C6-7 (p = 0.0017, OR 0.061). A small CSA during flexion was found to be significantly associated with a positive Babinski sign (p = 0.021, OR 0.90). The presence of ossification of the posterior longitudinal ligament (p = 0.0045, OR 0.31) and a larger C2-7 angle during flexion (p = 0.01, OR 0.89) were significantly associated with abnormal great toe proprioception (GTP). This study found that the Hoffmann reflex is associated with chronic and severe spinal cord compression but not the dynamic factors. The Babinski sign is associated with severe spinal cord compression during neck flexion. The GTP is associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.

268. Frailty is a better predictor than age of mortality and perioperative complications after surgery for Degenerative Cervical Myelopathy: An analysis of 41,369 patients from the NSQIP database 2010-2018

<h3>BACKGROUND CONTEXT</h3> The effect of frailty on the perioperative outcomes for patients undergoing surgery for degenerative cervical myelopathy (DCM) patients is poorly understood. <h3>PURPOSE</h3> The objective of the current study was to model the effect of various models of frailty on the perioperative outcomes for surgical DCM patients. <h3>STUDY DESIGN/SETTING</h3> Retrospective cohort study. <h3>PATIENT SAMPLE</h3> Patients under going surgery for DCM registered in the National Safety and Quality Improvment Database (NSQIP). <h3>OUTCOME MEASURES</h3> Mortality, adverse events, readmission, reoperation, length of hospital stay and discharge to nonhome destination. <h3>METHODS</h3> The modified frailty index 11- and 5-point (MFI-11, MFI-5), modified Charlson comorbidity index (mCCI) and ASA grade were calculated for patients with a diagnosis of DCM from the NSQIP database 2010-2018. The MFI-11 and MFI-5 scores were stratified into "Not Frail," "Prefrail," "Frail" and "Severely Frail." Univariate analysis was performed to assess the risk of mortality and adverse events by index. Multivariable modelling of age and frailty with a base model (type of surgical approach, number of operated levels and gender) was performed, with receiver operating characteristic area under the curve analysis (AUC) to define discriminative ability of each measure. <h3>RESULTS</h3> A total of 41,369 patients were included. Increasing frailty correlated significantly with increased risk of mortality, adverse events, longer hospital stay and risk of nonhome discharge destination. Comparing age and the other indices, the MFI-5 had the largest effect size for all variables (odds ratio 8.37 [Frail] - 27.70 [Severely Frail]). MFI-5 and mCCI have the best discriminative ability at predicting adverse events with multivariable modelling, but the base model with MFI-5 and age had the best predictive value (AUC=0.84). The effect size of frailty was greater than age alone for all outcomes, and MFI-5 had a categorical assessment correlation with MFI-11 of 0.988 (p<0.001). <h3>CONCLUSIONS</h3> Frailty has a larger effect size and better discriminative value compared to age alone to predict adverse events after surgery for DCM. A multivariable regression model using MFI-5 produced the most robust predictive tool, which substantiates the use of the MFI-5 in preference to the MFI-11 in clinical practice. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Cervical Steroid Injections Are Not Effective for Prevention of Surgical Treatment of Degenerative Cervical Myelopathy.

Retrospective cohort study. The objective of this study is to determine how often patients with degenerative cervical myelopathy (DCM) and initially treated with cervical steroid injections (CSI) and to determine whether these injections provide any benefit in delaying ultimate surgical treatment. All patients with a new diagnosis of DCM, without previous cervical spine surgery or steroid injections, were identified in PearlDiver, a large insurance database. Steroid injection and surgery timing was identified using Current Procedural Terminology (CPT) codes. Multivariate logistic regression identified associations with surgical treatment. A total of 686 patients with DCM were identified. Pre-surgical cervical spine steroid injections were utilized in 244 patients (35.6%). All patients underwent eventual surgical treatment. Median time from initial DCM diagnosis to surgery was 75.5 days (mean 351.6 days; standard deviation 544.9 days). Cervical steroid injections were associated with higher odds of surgery within 1 year (compared to patients without injections, OR = 1.44, P < .001) and at each examined time point through 5 years (OR = 2.01, P < .001). In multivariate analysis comparing injection types, none of the 3 injection types were associated with decreased odds of surgery within 1 month of diagnosis. While cervical steroid injections continue to be commonly performed in patients with DCM, there is an overall increased odds of surgery after any type of cervical injection. Therefore injections should not be used to prevent surgical management of DCM.