TY - JOUR
T1 - Geographic variations in clinical presentation and outcomes of decompressive surgery in patients with symptomatic degenerative cervical myelopathy
T2 - analysis of a prospective, international multicenter cohort study of 757 patients
AU - Fehlings, Michael G.
AU - Kopjar, Branko
AU - Ibrahim, Ahmed
AU - Tetreault, Lindsay A.
AU - Arnold, Paul M.
AU - Defino, Helton
AU - Kale, Shashank Sharad
AU - Yoon, S. Tim
AU - Barbagallo, Giuseppe M.
AU - Bartels, Ronald H.M.
AU - Zhou, Qiang
AU - Vaccaro, Alexander R.
AU - Zileli, Mehmet
AU - Tan, Gamaliel
AU - Yukawa, Yasutsugu
AU - Brodke, Darrel S.
AU - Shaffrey, Christopher I.
AU - Santos de Moraes, Osmar
AU - Woodard, Eric J.
AU - Scerrati, Massimo
AU - Tanaka, Masato
AU - Toyone, Tomoaki
AU - Sasso, Rick C.
AU - Janssen, Michael E.
AU - Gokaslan, Ziya L.
AU - Alvarado, Manuel
AU - Bolger, Ciaran
AU - Bono, Christopher M.
AU - Dekutoski, Mark B.
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/4
Y1 - 2018/4
N2 - Background Context: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness. Purpose: The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions. Study Design/Setting: This is a multicenter international prospective cohort study. Patient Sample: This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine. Outcome Measures: The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade. Materials and Methods: The baseline characteristics, disease causation, surgical approaches, and outcomes at 12 and 24 months were compared among four regions: Europe, Asia Pacific, Latin America, and North America. Results: Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalent in Asia Pacific (35.33%) and in Europe (31.75%), and hypertrophy of the ligamentum flavum was most prevalent in Latin America (61.25%). Surgical approaches varied by region; the majority of cases in Europe (71.43%), Asia Pacific (60.67%), and North America (59.10%) were managed anteriorly, whereas the posterior approach was more common in Latin America (66.25%). At the 24-month follow-up, patients from North America and Asia Pacific exhibited greater improvements in mJOA and Nurick scores than those from Europe and Latin America. Patients from Asia Pacific and Latin America demonstrated the most improvement on the NDI and SF-36v2 PCS. The longest duration of hospital stay was in Asia Pacific (14.16 days), and the highest rate of complications (34.9%) was reported in Europe. Conclusions: Regional differences in demographics, causation, and surgical approaches are significant for patients with DCM. Despite these variations, surgical decompression for DCM appears effective in all regions. Observed differences in the extent of postoperative improvements among the regions should encourage the standardization of care across centers and the development of international guidelines for the management of DCM.
AB - Background Context: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness. Purpose: The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions. Study Design/Setting: This is a multicenter international prospective cohort study. Patient Sample: This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine. Outcome Measures: The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade. Materials and Methods: The baseline characteristics, disease causation, surgical approaches, and outcomes at 12 and 24 months were compared among four regions: Europe, Asia Pacific, Latin America, and North America. Results: Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalent in Asia Pacific (35.33%) and in Europe (31.75%), and hypertrophy of the ligamentum flavum was most prevalent in Latin America (61.25%). Surgical approaches varied by region; the majority of cases in Europe (71.43%), Asia Pacific (60.67%), and North America (59.10%) were managed anteriorly, whereas the posterior approach was more common in Latin America (66.25%). At the 24-month follow-up, patients from North America and Asia Pacific exhibited greater improvements in mJOA and Nurick scores than those from Europe and Latin America. Patients from Asia Pacific and Latin America demonstrated the most improvement on the NDI and SF-36v2 PCS. The longest duration of hospital stay was in Asia Pacific (14.16 days), and the highest rate of complications (34.9%) was reported in Europe. Conclusions: Regional differences in demographics, causation, and surgical approaches are significant for patients with DCM. Despite these variations, surgical decompression for DCM appears effective in all regions. Observed differences in the extent of postoperative improvements among the regions should encourage the standardization of care across centers and the development of international guidelines for the management of DCM.
KW - Decompression
KW - Geographic variation
KW - Myelopathy
KW - Surgical
KW - Treatment efficacy
KW - Treatment outcome
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U2 - 10.1016/j.spinee.2017.08.265
DO - 10.1016/j.spinee.2017.08.265
M3 - Article
AN - SCOPUS:85031313575
SN - 1529-9430
VL - 18
SP - 593
EP - 605
JO - Spine Journal
JF - Spine Journal
IS - 4
ER -