Introduction: Cervical spondylotic myelopathy (CSM) is a common yet potentially serious condition, accounting for nearly 2% of all hospital admissions. However, the specific comparative magnitude of the impact of CSM on general health status is unknown. We compare (SF-36 PCS and MCS) values of other disease states to those of CSM to assess its relative impact on health.
Methods: Post-hoc analysis of data acquired through the prospective multicenter AOSpine North American CSM Study. Inclusion criteria were: symptomatic CSM, cervical cord compression via MRI or CT myelography, age over 18, and baseline SF-36 PCS/MCS. Descriptive statistics were used to characterize mean age, gender distribution, and HRQOL. SF-36 PCS and MCS scores were compared to United States (U.S.) normative values and disease specific norms using student’s paired t-test. ANOVA was used to assess differences between multiple age groups and offset from normative age-matched values. P-value of < 0.05 was considered statistically significant.
Results: 285 patients met inclusion criteria. Mean age was 56.6+12.0 years with 40% female (n=113). Baseline health scores revealed disability and myelopathy: SF-36 PCS 34.5+9.8, SF-36 MCS 41.5± 14.4, NDI 41.3+20.5, mJOA 12.8+2.8, and Nurick grade 4.1+1.0. Patients with CSM had a significantly worse SF-36 PCS and MCS compared to a normal healthy population (Table 1), and disease states including cancer, hypertension, chronic lung disease, and diabetes, p < 0.05 (Table 2). SF-36 PCS values in CSM were significantly lower than most disease states assessed except angina and myocardial infarction; congestive heart failure patients had even greater baseline disability.
Conclusions: CSM is a debilitating disease that significantly impacts quality of life and physical function to an extent greater than diabetes or cancer. These results highlight the impact of myelopathy on physical functioning, and suggest that it warrants similar research and health policy attention as more well-studied diseases that affect the general U.S. population.
Patient Care: It highlights the importance of CSM as a pathology that is just as debilitating as cardiac disease, that is underappreciated among multi-disciplinary providers, and warrants more research as it is impacting a greater proportion of patients in a way that significantly hinders quality of life.
Learning Objectives: By the conclusion of this session, participants should be able to describe the importance of CSM as it relates to different acute and chronic medical disease states, and discuss in small groups what future research warrants.
References: 1) Fehlings MG, Wilson JR, Kopjar B, Yoon ST, Arnold PM, Massicotte EM, et al. Efficacy and safety of surgical decompression in patients with cervical spondylotic myelopathy: results of the AOSpine North America prospective multi-center study. The Journal of bone and joint surgery American volume. 2013 Sep 18;95(18):1651-8.
2) Fehlings MG, Ibrahim A, Tetreault L, Albanese V, Alvarado M, Arnold P, et al. A Global Perspective on the Outcomes of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy: Results from the Prospective Multicenter AOSpine International Study on 479 patients. Spine. 2015 May 27.
3)Bess SL, B.; Fu KM.: McCarthy I.; Lafage V.; Schwab F.; Shaffrey C.; Ames C.; Akbarnia B.; Kim HJ.; Kelly M.; Burton D.; Hart R.; Klineberg E.; Kebaish K.; Hostin R.; Mundis G.; Mummaneni P.; Smith JS.; International Spine Study Group. The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases. Spine. 2015.