scholarly journals Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

2016 ◽  
Vol 40 (6) ◽  
pp. E14 ◽  
Author(s):  
Lindsay Tetreault ◽  
Jefferson R. Wilson ◽  
Mark R. N. Kotter ◽  
Aria Nouri ◽  
Pierre Côté ◽  
...  
Keyword(s):  
Relative Risk ◽  
Cervical Myelopathy ◽  
Univariate Analysis ◽  
Japanese Orthopaedic Association ◽  
Minimum Clinically Important Difference ◽  
Duration Of Symptoms ◽  
Clinically Important Difference ◽  
Younger Age ◽  
Degenerative Cervical Myelopathy ◽  
Unstable Gait

OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower-limb spasticity, and broad-based unstable gait. The final model included age (relative risk [RR] 0.924, p < 0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS In this large multinational prospective cohort, 70% of patients treated surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The key predictors of achieving an MCID on the mJOA scale were younger age, shorter duration of symptoms, nonsmoking status, and lack of significant gait impairment.

scholarly journals Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 53S-69S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
Shekar Kurpad ◽  
Darrel S. Brodke ◽  
Jefferson R. Wilson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Operative Treatment ◽  
Functional Impairment ◽  
Cervical Myelopathy ◽  
Surgical Intervention ◽  
Japanese Orthopaedic Association ◽  
Duration Of Symptoms ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

Study Design: Systematic review. Objectives: The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. Methods: A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results: Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). Conclusion: Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.

scholarly journals Change in Function, Pain, and Quality of Life Following Structured Nonoperative Treatment in Patients With Degenerative Cervical Myelopathy: A Systematic Review

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 42S-52S ◽  
Author(s):  
Lindsay A. Tetreault ◽  
John Rhee ◽  
Heidi Prather ◽  
Brian K. Kwon ◽  
Jefferson R. Wilson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cervical Myelopathy ◽  
Japanese Orthopaedic Association ◽  
Cochrane Collaboration ◽  
Japanese Orthopaedic Association Score ◽  
Nonoperative Treatment ◽  
Duration Of Symptoms ◽  
Degenerative Cervical Myelopathy

Study Design: Systematic review. Objectives: The objective of this study was to conduct a systematic review to determine (1) change in function, pain, and quality of life following structured nonoperative treatment for degenerative cervical myelopathy (DCM); (2) variability of change in function, pain, and quality of life following different types of structured nonoperative treatment; (3) differences in outcomes observed between certain subgroups (eg, baseline severity score, duration of symptoms); and (4) negative outcomes and harms resulting from structured nonoperative treatment. Methods: A systematic search was conducted in Embase, PubMed, and the Cochrane Collaboration for articles published between January 1, 1950, and February 9, 2015. Studies were included if they evaluated outcomes following structured nonoperative treatment, including therapeutic exercise, manual therapy, cervical bracing, and/or traction. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation Working Group. Results: Of the 570 retrieved citations, 8 met inclusion criteria and were summarized in this review. Based on our results, there is very low evidence to suggest that structured nonoperative treatment for DCM results in either a positive or negative change in function as evaluated by the Japanese Orthopaedic Association score. Conclusion: There is a lack of evidence to determine the role of nonoperative treatment in patients with DCM. However, in the majority of studies, patients did not achieve clinically significant gains in function following structured nonoperative treatment. Furthermore, 23% to 54% of patients managed nonoperatively subsequently underwent surgical treatment.

Is Preoperative Duration of Symptoms a Significant Predictor of Functional Outcomes in Patients Undergoing Surgery for the Treatment of Degenerative Cervical Myelopathy?

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 642-647 ◽  
Author(s):  
Lindsay Tetreault ◽  
Jefferson R Wilson ◽  
Mark R N Kotter ◽  
Pierre Côté ◽  
Aria Nouri ◽  
...  
Keyword(s):  
Functional Impairment ◽  
Cervical Myelopathy ◽  
Functional Outcomes ◽  
Short Form ◽  
Japanese Orthopaedic Association ◽  
Neck Disability Index ◽  
Analysis Of Covariance ◽  
Duration Of Symptoms ◽  
Change Scores ◽  
Degenerative Cervical Myelopathy

Abstract BACKGROUND Preoperative duration of symptoms may significantly impact outcomes in patients treated surgically for degenerative cervical myelopathy (DCM). OBJECTIVE To (i) analyze whether duration of symptoms is associated with preoperative functional impairment, disability, and quality of life and (ii) determine the optimal timing for decompressive surgery. METHODS Patients with DCM were prospectively enrolled in either the AOSpine North American or International study at 26 global sites (n = 757). Postoperative functional impairment was evaluated at 1-yr using the modified Japanese Orthopaedic Association (mJOA) score. Change scores between baseline and 1-yr were computed for the mJOA. Duration of symptoms was dichotomized into a “short” and “long” group at several cut-offs. Analysis of covariance was used to evaluate differences in change scores on the mJOA between duration of symptoms groups in 4-mo increments. RESULTS Our cohort consisted of 424 men and 255 women, with a mean duration of symptoms of 26.1 ± 36.4 mo (0.25-252 mo). Duration of symptoms was not correlated with preoperative mJOA, Nurick, Neck Disability Index, or Short-Form (SF)-36 Physical and Mental Component Scores. Patients with a duration of symptoms shorter than 4 mo had significantly better functional outcomes on the mJOA than patients with a longer duration of symptoms (>4 mo). Thirty-two months was also a significant cut-off. CONCLUSION Patients who are operated on within 4 mo of symptom presentation have better mJOA outcomes than those treated after 4 mo. It is recommended that patients with DCM are diagnosed in a timely fashion and managed appropriately.

Minimum Clinically Important Difference in SF-36 Scores for Use in Degenerative Cervical Myelopathy

Spine ◽  
2018 ◽  
Vol 43 (21) ◽  
pp. E1260-E1266 ◽  
Author(s):  
Jetan H. Badhiwala ◽  
Christopher D. Witiw ◽  
Farshad Nassiri ◽  
Muhammad A. Akbar ◽  
Blessing Jaja ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Minimum Clinically Important Difference ◽  
Clinically Important Difference ◽  
Sf 36 ◽  
Degenerative Cervical Myelopathy

scholarly journals Frailty Is a Better Predictor than Age of Mortality and Perioperative Complications after Surgery for Degenerative Cervical Myelopathy: An Analysis of 41,369 Patients from the NSQIP Database 2010–2018

2020 ◽  
Vol 9 (11) ◽  
pp. 3491
Author(s):  
Jamie R. F. Wilson ◽  
Jetan H. Badhiwala ◽  
Ali Moghaddamjou ◽  
Albert Yee ◽  
Jefferson R. Wilson ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Effect Size ◽  
Cervical Myelopathy ◽  
Frailty Index ◽  
Univariate Analysis ◽  
Predictive Tool ◽  
Improvement Program ◽  
Co Morbidity ◽  
Degenerative Cervical Myelopathy

Background: The ability of frailty compared to age alone to predict adverse events in the surgical management of Degenerative Cervical Myelopathy (DCM) has not been defined in the literature. Methods: 41,369 patients with a diagnosis of DCM undergoing surgery were collected from the National Surgical Quality Improvement Program (NSQIP) Database 2010–2018. Univariate analysis for each measure of frailty (modified frailty index 11- and 5-point; MFI-11, MFI-5), modified Charlson Co-morbidity index and ASA grade) were calculated for the following outcomes: mortality, major complication, unplanned reoperation, unplanned readmission, length of hospital stay, and discharge to a non-home destination. Multivariable modeling of age and frailty with a base model was performed to define the discriminative ability of each measure. Results: Age and frailty have a significant effect on all outcomes, but the MFI-5 has the largest effect size. Increasing frailty correlated significantly with the risk of perioperative adverse events, longer hospital stay, and risk of a non-home discharge destination. Multivariable modeling incorporating MFI-5 with age and the base model had a robust predictive value (0.85). MFI-5 had a high categorical assessment correlation with a MFI-11 of 0.988 (p < 0.001). Conclusions and Relevance: Measures of frailty have a greater effect size and a higher discriminative value to predict adverse events than age alone. MFI-5 categorical assessment is essentially equivalent to the MFI-11 score for DCM patients. A multivariable model using MFI-5 provides an accurate predictive tool that has important clinical applications.

Predictors of Return to Normal Neurological Function After Surgery for Moderate and Severe Degenerative Cervical Myelopathy: An Analysis of A Global AOSpine Cohort of Patients

Neurosurgery ◽  
2019 ◽  
Vol 85 (5) ◽  
pp. E917-E923 ◽  
Author(s):  
Rafael De la Garza Ramos ◽  
Aria Nouri ◽  
Jonathan Nakhla ◽  
Murray Echt ◽  
Yaroslav Gelfand ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Multiple Logistic Regression Analysis ◽  
Japanese Orthopaedic Association ◽  
Area Under The Curve ◽  
Neurological Function ◽  
International Studies ◽  
Patient Counseling ◽  
Multicenter Studies ◽  
Degenerative Cervical Myelopathy ◽  
Walking Time

Abstract BACKGROUND Multiple studies have established the safety and efficacy of surgical intervention for degenerative cervical myelopathy (DCM). Although the main goal of surgery is symptom stabilization, a subset of patients achieves remarkable improvements. OBJECTIVE To identify predictors of return to normal neurological function after surgery for moderate or severe DCM. METHODS This is an analysis of 2 prospective multicenter studies (the AOSpine CSM-North America and CSM-International studies) conducted between 2005 and 2011. For patients with complete preoperative magnetic resonance imaging (MRI) and 2-yr follow-up, characteristics were compared between those who achieved a modified Japanese Orthopaedic Association (mJOA) score of 18 at 2 yr (no signs of myelopathy) vs controls. Only patients with baseline mJOA ≤ 14 (moderate and severe myelopathy) were included to minimize ceiling effects. RESULTS A total of 51 patients (20.3%) out of 251 with moderate or severe baseline myelopathy achieved an mJOA score of 18 at 2 yr. On stepwise multiple logistic regression analysis, T1-weighted (T1W1)-hypointensity (odds ratio [OR] 0.10; 95% confidence interval [CI], 0.01-0.79; P = .03) and longer walking time on the 30-m walking test (OR 0.95; 95% CI, 0.92-0.99; P = .03) were independent predictors of outcome, with an area under the curve of 0.71 for the model. CONCLUSION In this study, T1W-hypointensity on MRI and longer walking time were found to predict a less likelihood of achieving return to normal neurological function after surgery for moderate or severe DCM. These findings may provide useful information for patient counseling and perioperative expectations.

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