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Spine J. 2018 Apr;18(4):593-605. doi: 10.1016/j.spinee.2017.08.265. Epub 2017 Sep 6.

Geographic variations in clinical presentation and outcomes of decompressive surgery in patients with symptomatic degenerative cervical myelopathy: analysis of a prospective, international multicenter cohort study of 757 patients.

Author information

1
Department of Surgery, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada. Electronic address: michael.fehlings@uhn.on.ca.
2
Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA.
3
Department of Surgery, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada.
4
Department of Surgery, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada; Graduate Entry Medicine, University College Cork, Cork, Ireland.
5
Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA.
6
Department of Medicine, University of São Paulo, Ribeirão Preto, São Paulo 03178-200, Brazil.
7
Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
8
Department of Orthopaedic Surgery, Emory University, 201 Dowman Drive, Atlanta, GA 30322, USA.
9
Department of Neurosurgery, Policlinico "G. Rodolico" University Hospital, Via S. Sofia, Catania 95125, Italy.
10
Department of Neurosurgery, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, Nijmegen 6625, The Netherlands.
11
Department of Orthopedics, Southwest Hospital, First Affiliated Hospital of the Third Military Medical University, Gaoyan Rock Street 30, Chongqing, China.
12
Rothman Institute, Thomas Jefferson University Hospital, 925 Chestnut St, Philadelphia, PA 19107, USA.
13
Department of Neurosurgery, Ege University, Erzene Mahallesi, Gençlik Caddesi, Izmir 35040, Turkey.
14
Department of Orthopaedics, Alexandra Hospital, 378 Alexandra Rd, Singapore 159964.
15
Department of Orthopaedic Surgery, Chubu Rosai Hospital, 1 Chome-10-6 Komei, Minato Ward, Nagoya 455-8530, Japan.
16
Department of Orthopaedics, University of Utah, Salt Lake City, 590 Wakara Way, UT 84108, USA.
17
Department of Neurological Surgery, University of Virginia, 1215 Lee St, Charlottesville, VA 22908, USA.
18
Department of Neurosurgery, Hospital Santa Marcelina, R. Santa Marcelina, São Paulo 08260-005, Brazil.
19
Department of Surgery, New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA.
20
Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Via Conca, 71, Ancona 60126, Italy.
21
Department of Orthopedic Surgery, Okayama University Hospital, 2 Chome-5-1 Shikatacho, Kita Ward, Okayama 700-8558, Japan.
22
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 2 Chome-11-1 Kaga, Itabashi, Tokyo 173-8606, Japan.
23
Indiana Spine Group, 13225 N Meridian St, Carmel, IN 46032, USA.
24
Spine Education and Research Institute, 9005 Grant St, Denver, CO 80229, USA.
25
Department of Neurosurgery/Spine Division, Johns Hopkins University, 3400 N. Charles St, Baltimore, MD 21218, USA.
26
Department of Surgery, Hospital San Juan de Dios, Calle-C, Caracas, Venezuela.
27
Department of Neurosurgery, Beaumont Hospital, PO Box 1297, Beaumont Rd, Dublin 9, Ireland.
28
Department of Orthopedics, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
29
The CORE Institute, Sun City West, 14520 W Granite Valley Dr, AZ 85375, USA.

Abstract

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.

KEYWORDS:

Decompression; Geographic variation; Myelopathy; Surgical; Treatment efficacy; Treatment outcome

PMID:
28888674
DOI:
10.1016/j.spinee.2017.08.265
[Indexed for MEDLINE]

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