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  • Geographical Variations in the Management and Outcome Outcomes of Decompressive Surgery in Patients with Symptomatic Degenerative Cervical Myelopathy: Analysis of International Prospective Multicenter

    Final Number:

    M.G. Fehlings MD, PhD, FRCS(C), FACS; A. Ibrahim MBBS, MRCS, PhD; L. Tetreault Bsc; B. Kopjar MD; P. Arnold MD; H. Defino PhD; S. Kale MBBS, MS, MCh, MD; S. Yoon MD; G. Barbagallo MD; R. Bartels MD, PhD; Q. Zhou MD; A. Vaccaro MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: Degenerative cervical myelopathy (DCM) is one of the most common causes of adult spinal cord impairment worldwide. Increasingly DCM is being treated through surgery globally. However, currently there is no consensus on best surgical methods. There is also paucity in the literature on regional variations of treatment and outcome.

    Methods: This is a multicenter international prospective investigation of 757 surgically treated DCM patients from Europe (E), Asia-Pacific (AP), Latin America (LA), and North America (NA). Outcome measures used were Modified Japanese Orthopedic Association scale (mJOA), Nurick score, Neck Disability Index (NDI), and Short-Form 36v2 (SF36v2). 85.44% of patients completed 1 year follow up.

    Results: Of the 757 patients, 80 were from LA, 126 from E, 150 from AP and 401 from NA. There were significant differences in age, gender, etiology and surgical methods. The mean age was 56.4 years (SD=11.83). Patients were younger (mean 3.27 years) in AP and LA compared to E and NA. Race differed across the regions (P<0.0001). Etiological variations showed that OPLL was most frequently seen in AP (35.33%) followed by E (32.28%) and least commonly in NA (11.72%). Preoperative mJOA (p=0.2729) and NDI (p=0.3364) were similar but SF36v2 (p<0.0012) and Nurick (p<0.0001) were significantly different. The surgical approach varied by region (p<0.0001). While majority of LA patients had posterior surgery, 3 in 4 patients in the other regions had anterior surgery. All patients gained significant improvements in mJOA, NDI, SF36 and Nurick after surgery. The greatest improvements on mJOA were in AP (3.02±2.80), followed by NA (2.85±2.82), LA (1.98±2.66), and E (1.30±2.42) (p<0.0001). After adjusting for patient, disease and surgical characteristics, the mJOA regional differences remained significant (p<0.0001).

    Conclusions: There are regional variations in demographics, DCM presentation, etiology and outcome. Following surgery patients in all regions improved but the margins of improvement varied between regions.

    Patient Care: To determine if surgical treatment for CSM is associated with significant differences in outcomes in different regions.

    Learning Objectives: By the conclusion of this session, participants will learn this large prospective global clinical study shows that surgical treatment for CSM is associated with significant differences in outcomes in different regions.


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