Congratulations to our very own Michael E. Janssen, DO, on the recent publication of the article and research study, “Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy”, of which he was co-author, in the Sept. 18, 2013 issue of Journal of Bone and Joint Surgery! Below you may find a portion of the article, or you may view it in full here.
Efficacy and Safety of Surgical Decompression in Patients with Cervical Spondylotic Myelopathy
Results of the AOSpine North America Prospective Multi-Center Study
Michael G. Fehlings, MD, PhD, Jefferson R. Wilson, MD, Branko Kopjar, MD, PhD, Sangwook Tim Yoon, MD, PhD, Paul M. Arnold, MD, Eric M. Massicotte, MD, Alexander R. Vaccaro, MD, PhD, Darrel S. Brodke, MD, Christopher I. Shaffrey, MD, Justin S. Smith, MD, Eric J. Woodard, MD, Robert J. Banco, MD, Jens R. Chapman, MD, Michael E. Janssen, DO, Christopher M. Bono, MD, Rick C. Sasso, MD, Mark B. Dekutoski, MD, and Ziya L. Gokaslan, MD
Background: Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction worldwide. The objective of this study was to evaluate the impact of surgical decompression on functional, quality-of-life, and disability outcomes at one year after surgery in a large cohort of patients with this condition.
Methods: Adult patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression were enrolled at twelve North American centers from 2005 to 2007. At enrollment, the myelopathy was categorized as mild (modified Japanese Orthopaedic Association [mJOA] score ‡ 15), moderate (mJOA = 12 to 14), or severe (mJOA < 12). Patients were followed prospectively for one year, at which point the outcomes of interest included the mJOA score, Nurick grade, Neck Disability Index (NDI), and Short Form-36 version 2 (SF-36v2). All outcomes at one year were compared with the preoperative values with use of univariate paired statistics. Outcomes were also compared among the severity classes with use of one-way analysis of variance. Finally, a multivariate analysis that adjusted for baseline differences among the severity groups was performed. Treatment-related complication data were collected and the overall complication rate was calculated.
Results: Eighty-five (30.6%) of the 278 enrolled patients had mild cervical spondylotic myelopathy, 110 (39.6%) had moderate disease, and 83 (29.9%) had severe disease preoperatively. One-year follow-up data were available for 222 (85.4%) of 260 patients. There was a significant improvement from baseline to one year postoperatively (p < 0.05) in the mJOA score, Nurick grade, NDI score, and all SF-36v2 health dimensions (including the mental and physical health composite scores) except general health. With the exception of the change in the mJOA, the degree of improvement did not depend on the severity of the preoperative symptoms. These results remained unchanged after adjusting for relevant confounders in the multivariate analysis. Fifty-two patients experienced complications (prevalence, 18.7%), with no significant differences among the severity groups.
Conclusions: Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories. Furthermore, complication rates observed in the study were commensurate with those in previously reported cervical spondylotic myelopathy series.
Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 100 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients.
Source: The Journal of Bone and Joint Surgery, Incorporated; September 1, 2013.
