Efficacy and safety of surgery for mild degenerative cervical myelopathy: results of the aospine North America and international prospective multicenter studies

Jetan H. Badhiwala, Christopher D. Witiw, Farshad Nassiri, Muhammad A. Akbar, Seyed Alireza Mansouri, Jefferson R. Wilson, Michael G. Fehlings

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

BACKGROUND There is controversy over the optimal treatment strategy for patients with mild degenerative cervical myelopathy (DCM). OBJECTIVE To evaluate the degree of impairment in baseline quality of life as compared to population norms, as well as functional, disability, and quality of life outcomes following surgery in a prospective cohort of mild DCM patients undergoing surgical decompression. METHODS We identified patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] 15 to 17) enrolled in the prospective, multicenter AOSpine CSM-NA or CSM-I trials. Baseline quality of life Short Form-36 version 2 (SF-36v2) was compared to population norms by the standardized mean difference (SMD). Outcomes, including functional status (mJOA, Nurick grade), disability (NDI [Neck Disability Index]), and quality of life (SF-36v2), were evaluated at baseline and 6 mo, 1 yr, and 2 yr after surgery. Postoperative complications within 30 d of surgery were monitored. RESULTS One hundred ninety-three patients met eligibility criteria. Mean age was 52.4 yr. There were 67 females (34.7%). Patients had significant impairment in all domains of the SF-36v2 compared to population norms, greatest for Social Functioning (SMD -2.33), Physical Functioning (SMD -2.31), and Mental Health (SMD -2.30). A significant improvement in mean score from baseline to 2-yr follow-up was observed for all major outcome measures, including mJOA (0.87, P <.01), Nurick grade (-1.13, P <.01), NDI (-12.97, P <.01), and SF-36v2 Physical Component Summary (PCS) (5.75, P <.01) and Mental Component Summary (MCS) (6.93, P <.01). The rate of complication was low. CONCLUSION Mild DCM is associated with significant impairment in quality of life. Surgery results in significant gains in functional status, level of disability, and quality of life.

Original languageEnglish (US)
Pages (from-to)890-897
Number of pages8
JournalClinical Neurosurgery
Volume84
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Spinal Cord Diseases
North America
Multicenter Studies
Quality of Life
Prospective Studies
Safety
Orthopedics
Population
Surgical Decompression
Mental Health
Neck
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Badhiwala, Jetan H. ; Witiw, Christopher D. ; Nassiri, Farshad ; Akbar, Muhammad A. ; Mansouri, Seyed Alireza ; Wilson, Jefferson R. ; Fehlings, Michael G. / Efficacy and safety of surgery for mild degenerative cervical myelopathy : results of the aospine North America and international prospective multicenter studies. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 4. pp. 890-897.
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title = "Efficacy and safety of surgery for mild degenerative cervical myelopathy: results of the aospine North America and international prospective multicenter studies",
abstract = "BACKGROUND There is controversy over the optimal treatment strategy for patients with mild degenerative cervical myelopathy (DCM). OBJECTIVE To evaluate the degree of impairment in baseline quality of life as compared to population norms, as well as functional, disability, and quality of life outcomes following surgery in a prospective cohort of mild DCM patients undergoing surgical decompression. METHODS We identified patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] 15 to 17) enrolled in the prospective, multicenter AOSpine CSM-NA or CSM-I trials. Baseline quality of life Short Form-36 version 2 (SF-36v2) was compared to population norms by the standardized mean difference (SMD). Outcomes, including functional status (mJOA, Nurick grade), disability (NDI [Neck Disability Index]), and quality of life (SF-36v2), were evaluated at baseline and 6 mo, 1 yr, and 2 yr after surgery. Postoperative complications within 30 d of surgery were monitored. RESULTS One hundred ninety-three patients met eligibility criteria. Mean age was 52.4 yr. There were 67 females (34.7{\%}). Patients had significant impairment in all domains of the SF-36v2 compared to population norms, greatest for Social Functioning (SMD -2.33), Physical Functioning (SMD -2.31), and Mental Health (SMD -2.30). A significant improvement in mean score from baseline to 2-yr follow-up was observed for all major outcome measures, including mJOA (0.87, P <.01), Nurick grade (-1.13, P <.01), NDI (-12.97, P <.01), and SF-36v2 Physical Component Summary (PCS) (5.75, P <.01) and Mental Component Summary (MCS) (6.93, P <.01). The rate of complication was low. CONCLUSION Mild DCM is associated with significant impairment in quality of life. Surgery results in significant gains in functional status, level of disability, and quality of life.",
author = "Badhiwala, {Jetan H.} and Witiw, {Christopher D.} and Farshad Nassiri and Akbar, {Muhammad A.} and Mansouri, {Seyed Alireza} and Wilson, {Jefferson R.} and Fehlings, {Michael G.}",
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Efficacy and safety of surgery for mild degenerative cervical myelopathy : results of the aospine North America and international prospective multicenter studies. / Badhiwala, Jetan H.; Witiw, Christopher D.; Nassiri, Farshad; Akbar, Muhammad A.; Mansouri, Seyed Alireza; Wilson, Jefferson R.; Fehlings, Michael G.

In: Clinical Neurosurgery, Vol. 84, No. 4, 01.04.2019, p. 890-897.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Efficacy and safety of surgery for mild degenerative cervical myelopathy

T2 - results of the aospine North America and international prospective multicenter studies

AU - Badhiwala, Jetan H.

AU - Witiw, Christopher D.

AU - Nassiri, Farshad

AU - Akbar, Muhammad A.

AU - Mansouri, Seyed Alireza

AU - Wilson, Jefferson R.

AU - Fehlings, Michael G.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BACKGROUND There is controversy over the optimal treatment strategy for patients with mild degenerative cervical myelopathy (DCM). OBJECTIVE To evaluate the degree of impairment in baseline quality of life as compared to population norms, as well as functional, disability, and quality of life outcomes following surgery in a prospective cohort of mild DCM patients undergoing surgical decompression. METHODS We identified patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] 15 to 17) enrolled in the prospective, multicenter AOSpine CSM-NA or CSM-I trials. Baseline quality of life Short Form-36 version 2 (SF-36v2) was compared to population norms by the standardized mean difference (SMD). Outcomes, including functional status (mJOA, Nurick grade), disability (NDI [Neck Disability Index]), and quality of life (SF-36v2), were evaluated at baseline and 6 mo, 1 yr, and 2 yr after surgery. Postoperative complications within 30 d of surgery were monitored. RESULTS One hundred ninety-three patients met eligibility criteria. Mean age was 52.4 yr. There were 67 females (34.7%). Patients had significant impairment in all domains of the SF-36v2 compared to population norms, greatest for Social Functioning (SMD -2.33), Physical Functioning (SMD -2.31), and Mental Health (SMD -2.30). A significant improvement in mean score from baseline to 2-yr follow-up was observed for all major outcome measures, including mJOA (0.87, P <.01), Nurick grade (-1.13, P <.01), NDI (-12.97, P <.01), and SF-36v2 Physical Component Summary (PCS) (5.75, P <.01) and Mental Component Summary (MCS) (6.93, P <.01). The rate of complication was low. CONCLUSION Mild DCM is associated with significant impairment in quality of life. Surgery results in significant gains in functional status, level of disability, and quality of life.

AB - BACKGROUND There is controversy over the optimal treatment strategy for patients with mild degenerative cervical myelopathy (DCM). OBJECTIVE To evaluate the degree of impairment in baseline quality of life as compared to population norms, as well as functional, disability, and quality of life outcomes following surgery in a prospective cohort of mild DCM patients undergoing surgical decompression. METHODS We identified patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] 15 to 17) enrolled in the prospective, multicenter AOSpine CSM-NA or CSM-I trials. Baseline quality of life Short Form-36 version 2 (SF-36v2) was compared to population norms by the standardized mean difference (SMD). Outcomes, including functional status (mJOA, Nurick grade), disability (NDI [Neck Disability Index]), and quality of life (SF-36v2), were evaluated at baseline and 6 mo, 1 yr, and 2 yr after surgery. Postoperative complications within 30 d of surgery were monitored. RESULTS One hundred ninety-three patients met eligibility criteria. Mean age was 52.4 yr. There were 67 females (34.7%). Patients had significant impairment in all domains of the SF-36v2 compared to population norms, greatest for Social Functioning (SMD -2.33), Physical Functioning (SMD -2.31), and Mental Health (SMD -2.30). A significant improvement in mean score from baseline to 2-yr follow-up was observed for all major outcome measures, including mJOA (0.87, P <.01), Nurick grade (-1.13, P <.01), NDI (-12.97, P <.01), and SF-36v2 Physical Component Summary (PCS) (5.75, P <.01) and Mental Component Summary (MCS) (6.93, P <.01). The rate of complication was low. CONCLUSION Mild DCM is associated with significant impairment in quality of life. Surgery results in significant gains in functional status, level of disability, and quality of life.

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