Surgery For Degenerative Cervical Myelopathy Research Articles

Canadian Spine Society1.01: Do lumbar decompression and fusion patients recall their preoperative status? Recall bias in patient-reported outcomes1.02: Trends and costs of lumbar fusion and disc replacement surgeries in Ontario: a population-based study1.03: Ontario’s Inter-professional Spine Assessment and Education Clinics (ISAEC): patient, provider and system impact of an integrated model of care for the management of LBP1.04: Validation of the

# 1.01: Do lumbar decompression and fusion patients recall their preoperative status? Recall bias in patient-reported outcomes {#article-title-2} To characterize the accuracy of patient recall of pre-operative symptoms in a cohort of lumbar spine surgery patients. We analyzed consecutive patients

A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy.

Although generally safe and effective, surgery for the treatment of cervical spondylotic myelopathy (CSM) is associated with complications in 11%-38% of patients. Several predictors of postoperative complications have been proposed but few are used to detect high-risk patients. A standard approach to identifying "at-risk" patients would improve surgeons' ability to prevent and manage these complications. The authors aimed to compare the complication rates between various surgical procedures used to treat CSM and to identify patient-specific, clinical, imaging, and surgical predictors of complications. The authors conducted a systematic review of the literature and searched MEDLINE, MEDLINE in Process, EMBASE, and Cochrane Central Register of Controlled Trials from 1948 to September 2013. Cohort studies designed to evaluate predictors of complications and intervention studies conducted to compare different surgical approaches were included. Each article was critically appraised independently by 2 reviewers, and the evidence was synthesized according to the principles outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. A total of 5472 citations were retrieved. Of those, 60 studies met the inclusion criteria and were included in the review. These studies included 36 prognostic cohort studies and 28 comparative intervention studies. High evidence suggests that older patients are at a greater risk of perioperative complications. Based on low evidence, other clinical factors such as body mass index, smoking status, duration of symptoms, and baseline severity score, are not predictive of complications. With respect to surgical factors, low to moderate evidence suggests that estimated blood loss, surgical approach, and number of levels do not affect rates of complications. A longer operative duration (moderate evidence), however, is predictive of perioperative complications and a 2-stage surgery is related to an increased risk of major complications (high evidence). In terms of surgical techniques, higher rates of neck pain were found in patients undergoing laminoplasty compared with anterior spinal fusion (moderate evidence). In addition, with respect to laminoplasty techniques, there was a lower incidence of C-5 palsy in laminoplasty with concurrent foraminotomy compared with nonforaminotomy (low evidence). The current review suggests that older patients are at a higher risk of perioperative complications. A longer operative duration and a 2-stage surgery both reflect increased case complexity and can indirectly predict perioperative complications.

A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Data Set of 743 Subjects

Introduction Knowledge of important clinical predictors of surgical outcome can provide decision support to surgeons and enable them to appropriately manage their patients' expectations. This study aims to determine the most important global clinical predictors of surgical outcome in patients undergoing surgery for CSM, based on data from two multicenter prospective studies. Patients and Methods A total of 743 surgical patients with CSM participated in either the CSM-North America or CSM-International study. The model was developed to distinguish between patients with mild myelopathy postoperatively (mJOA ≥ 16) and those with substantial residual neurological impairment (mJOA < 16). Univariate analyses were performed to evaluate the relationship between outcome and various clinical predictors. Multivariate logistic regression was used to formulate the final prediction model. Results Univariate analyses demonstrated that the odds of achieving a score ≥ 16 decreased with the presence of certain symptoms, including impaired gait; the presence of certain signs such as lower limb spasticity; positive smoking status; a higher comorbidity score; more severe preoperative myelopathy; and older age. The final prediction model included age (OR = 0.97, p = 0.0017), duration of symptoms (OR = 0.88, p = 0.049), smoking status (OR = 0.51, p = 0.0018), impairment of gait (OR = 1.94, p = 0.0168), broad-based unstable gait (OR = 1.75, p = 0.0133), baseline severity (OR = 1.23, p < 0.0001), and comorbidity score (OR = 0.84, p = 0.0030). Conclusion Patients are more likely to achieve a score ≥ 16 if they are younger, have a shorter duration of symptoms, are less severe preoperatively, do not smoke, and do not have comorbidities or evidence of gait dysfunction.

A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 757 Subjects

A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 757 Subjects

A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 771 Subjects

Degenerative cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction worldwide. Surgery has been used for the treatment of CSM to arrest its progression, prevent further neurological disability and improve clinical status. However, it is often difficult to predict clinical outcomes in this heterogeneous patient population.