Format

Send to

Choose Destination
Neurospine. 2019 Jul 9. doi: 10.14245/ns.1938010.005. [Epub ahead of print]

Degenerative Cervical Myelopathy: A Seven-Letter Coding System That Supports Decision Making for the Surgical Approach.

Author information

1
Clinic for Spine Surgery, Schoen Clinic Hamburg Eilbek, Hamburg, Germany.
2
Spine Center, Benedictus Hospital, Tutzing, Germany.
3
Spine Center, Schoen Clinic Munich Harlaching, Hamburg, Germany.
4
Orthopedic Surgery, University of Toyama, Toyama, Japan.
5
Orthopedic Department, Uppsala University, Uppsala, Sweden.
6
Spine Center, University of Nottingham, Nottingham, UK.
7
Spine Center, SRH-Clinic, Karlsbad-Langensteinbach, Germany.
8
Spine Center, St. Josefs-Hospital, Wiesbaden, Germany.
9
University Medical Center, Spine Division, Columbia University, New York, NY, USA.
10
Spinal Unit, Royal Adelaide Hospital, Adelaide, Australia.

Abstract

Purpose:

To validate with a prospective study a decision-supporting coding system for the surgical approach for multi-level degenerative cervical myelopathy (mDCM).

Methods:

Ten cases were presented on an internet platform, including clinical and imaging data. A single approach (G1), a choice between two (G2), or three approaches (G3) were options. Senior and junior spine surgeons analyzed seven parameters: location and extension of the compression of the spinal cord; C-spine alignment and instability; general morbidity and bone diseases; and K-line and multi-level corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting seven letter code (7LC) suggested the surgical approach. Each surgeon performed two reads per case within eight weeks.

Results:

G1: Inter-rater reliability between junior surgeons improved from the first read (κ=0.40) to the second (κ=0.76; p<0.001) but did not change between senior surgeons (κ=0.85). The intra-rater reliability was similar for junior (κ=0.78) and senior (κ=0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice.

Conclusion:

The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.

KEYWORDS:

Degenerative cervical myelopathy; Multicenter study; Preoperative validation; Scores; Surgical treatment

PMID:
31284334
DOI:
10.14245/ns.1938010.005
Free full text

Supplemental Content

Full text links

Icon for Publishing M2Community
Loading ...
Support Center