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  • International Variations in the Clinical Presentation and Management of Cervical Spondylotic Myelopathy (CSM). One Year Outcomes of the AOSpine Multi-Center Prospective Study

    Final Number:

    Michael G. Fehlings MD; Branko Kopjar MD; Helton Defino MD; Shashank Sharad Kale MD; Guiseppe Barbagallo MD; Ronald H.M.A. Bartels MD; Qiang Zhou MD; Paul M. Arnold MD; Mehmet Zileli MD; Gamaliel Tan MD; Yasutsugu Yukawa MD; Osmar Moraes; Manuel Alvarado MD; Massimo Scerrati MD; Tomoaki Toyone MD; Masato Tanaka MD; Ciaran Bolger MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2011 Annual Meeting

    Introduction: Little information is available with respect to differences in global approaches to treatment of CSM.

    Methods: 521 patients with CSM were enrolled in a prospective multi-center controlled, cohort study involving 16 sites in Europe, Asia, South America and North America. Data were analyzed using multivariate techniques adjusting for baseline differences (demographics, surgical approach, number of levels and baseline outcome values) in patient populations.

    Results: 35.1 percent were females with an average age of 55.7 yrs (SD 12.6). Patients underwent anterior (59.6 percent) posterior (38.2 percent) or circumferential (2.2 percent) surgery. Significant differences in presentation and surgical approaches exist among the regions. 269 patients have completed 1 year follow-up. There has been a statistically (P < .01) and clinically significant improvement in all outcome parameters. mJOA improved from 12.6 ±2.8 at baseline to 15.0 ±2.7 at 12 months. NDI improved from 39.4 ±21.3 at baseline to 27.4 ±19.9 at 12 months. Nurick improved from 4.3 ±1.2 at baseline to 3.0 ±1.5 at 12 months. SF36 PCS improved from 35.4 ±8.6 at baseline to 43.3 ±10.1 at 12 months. SF36 MCS improved from 38.8 ±9.8 at baseline to 46.1 ±10.7 at 12 months. Site from Asia & Pacific and Latin America had better outcomes then the sites from North America and Europe.

    Conclusions: This large prospective global clinical study shows that surgical treatment for CSM is associated with significant improvements in generic and patient-specific outcome measures at one year. Significant variations in extent of improvement among the sites needs to be further investigated.

    Patient Care: There is still paucity of information regarding the success of surgery for CSM. This study demonstrates that surgery is highly effective and should be offered to symptomatic patients with CSM.

    Learning Objectives: To learn about efficacy of surgical treatment for CSM.


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