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A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 771 Subjects
Proceedings of the NASS 28th Annual Meeting / The Spine Journal 13 (2013) 1S–168S disease specific outcome measures allowing for baseline differences in clinical presentation between the two groups of patients. Longer term follow-up will be required to determine whether any differences in outcome between the two forms of treatment emerge. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2013.07.035
5. A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 771 Subjects Lindsay Tetreault1, Michael G. Fehlings, MD, PhD, FRCSC2, Branko Kopjar, MD, PhD3, Paul M. Arnold, MD4, Alexander R. Vaccaro, MD, PhD5, Eric M. Massicotte, MD, FRCSC6, Helton Luiz A. Defino, MD, PhD7, Giuseppe Barbagallo, MD8, Qiang Zhou9, Mehmet Zileli, MD10, Yasutsugu Yukawa, MD11, Massimo Scerrati, MD, PhD12, Tomoaki Toyone, MD, PhD13, Masato Tanaka, MD14, Christopher I. Shaffrey, MD15, Mark B. Dekutoski, MD16, Ziya L. Gokaslan, MD, FACS17, Christopher M. Bono, MD18; 1University Health Network, Toronto, ON, Canada; 2Toronto Western Hospital, Toronto, ON, Canada; 3Mercer Island, WA, US; 4 University of Kansas Medical Center, Department of Neurosurgery, Kansas City, KS, US; 5Rothman Institute, Philadelphia, PA, US; 6 University of Toronto, Toronto, ON, Canada; 7Universidade De Sao Paulo Faculdade De Medicina De Ribeirao Preto, Ribeirao Preto, SP, Brazil; 8 A.O.V. Policlinico, Catania, Italy; 9China; 10Izmir, Turkey; 11Chubu Rosai Hospital, Nagoya, Japan; 12Ancona, Marche, Italy; 13Teikyo University, Ichihara, Japan; 14Okayama, Japan; 15University of Virginia Department of Neurosurgery, Charlottesville, VA, US; 16The CORE Institute, Sun City West, AZ, US; 17Johns Hopkins University - Department of Neurosurgery, Baltimore, MD, US; 18Brigham & Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, US BACKGROUND CONTEXT: Degenerative cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction worldwide. Surgery has been used for the treatment of CSM to arrest its progression, prevent further neurological disability and improve clinical status. However, it is often difficult to predict clinical outcomes in this heterogeneous patient population. PURPOSE: The objective of this study is to develop a clinical prediction rule relating the best combination of clinical variables to surgical outcome, based on data from two multicenter prospective studies STUDY DESIGN/SETTING: Prospective multicenter study. PATIENT SAMPLE: Two hundred and seventy-eight patients diagnosed with degenerative cervical myelopathy were enrolled in the CSM-North American study at 12 different sites. An additional 493 patients participated in the CSM-International study from sixteen different global sites. OUTCOME MEASURES: The modified Japanese Orthopaedic Association (mJOA) score at one-year follow-up was dichotomized: a successful outcome was defined as an mJOA greater than or equal to sixteen and a failed outcome was a score less than sixteen. METHODS: Multicollinearity of all variables was evaluated. Univariate analyses were performed to evaluate the relationship between outcome and various clinical predictors including signs and symptoms, gender, smoking status, baseline mJOA, duration of symptoms, age and co-morbidities. A set of important variables for the final model was selected based on author consensus and statistical findings. Logistic regression was used to formulate the final prediction model and assess the impact of each variable on outcome. RESULTS: Univariate analyses demonstrated the odds of a successful outcome decreased with the presence of certain symptoms, including clumsy hands (OR: 1.48, 95% CI: 1.01-2.18, p50.045), impaired gait (OR: 4.10, 95% CI: 2.64-6.36, p!0.001) and limb weakness (OR: 2.19, 95% CI: 1.403.44, p50.0007); the presence of certain signs, including corticospinal
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distribution motor deficits (OR: 2.26, 95% CI: 1.63-3.15, p!0.0001), upgoing plantar responses (OR: 1.61 95% CI: 1.16-2.24, p50.0041) and lower limb spasticity (OR: 1.79 95% CI: 1.30-2.47, p50.0004); smoking (OR: 0.67 95% CI: 0.47-0.96, p50.028); the presence of cardiovascular co-morbidities (OR: 0.45 95% CI 0.31-0.64 p!0.0001); a lower baseline mJOA score (OR: 1.37 95% CI 1.27-1.47, p!0.0001); and older age (OR: 0.96, 95% 0.95-0.98, p!0.0001). The final clinical prediction rule included age (OR: 0.97, 95%CI: 0.95-0.99, p50.0045), duration of symptoms (OR: 0.88, 95% CI: 0.76-1.01, p50.070), smoking status (OR: 0.66, 95%CI; 0.41-1.07, p50.093), impairment of gait (OR: 2.48, 95% CI: 1.44-4.27, p50.0011) cardiovascular co-morbidities (0.62, 95% CI: 0.41-0.95, p-0.030) and baseline severity score (OR: 1.26, 95% CI: 1.151.38, p!0.0001). The area under the receiver operator (ROC) curve was 0.77, indicating good model prediction. CONCLUSIONS: Based on this study, we have identified a list of the most important predictors of surgical outcome for CSM. Submitted on behalf of the CSM-North America and CSM-International study investigators. FDA DEVICE/DRUG STATUS: ProDisc-C (Approved for this indication), Prestige (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.036
6. Moved to The Spine Journal Outstanding Paper Awards and Editors’ Choice Award Presentations Session http://dx.doi.org/10.1016/j.spinee.2013.07.037
7. C2 Nerve Root Transection during C1 Lateral Mass Screw Fixation: Does it Affect Functionality and Quality of Life? Michael C. Dewan, MD1, Saniya S. Godil, MD1, Clinton J. Devin, MD2, Matthew J. McGirt, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US BACKGROUND CONTEXT: Posterior atlantoaxial stabilization via C1 lateral mass screw fixation can be technically challenging yet is an effective procedure for C1-2 instability. Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis of the C1-2 motion segment and accurate C1 screw placement. However, concern of posterior-auricular numbness often precludes C2 sectioning in routine practice. PURPOSE: We set out to determine the clinical and functional consequences of routine sectioning of C2 nerve root during placement of C1 lateral mass screws. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: All patients who underwent posterior atlantoaxial stabilization via C1 lateral mass screw fixation at our institution over a two-year period. OUTCOME MEASURES: A standard questionnaire was used to determine the presence, severity and frequency of posterior auricular numbness or pain, and its effect on quality of life. Domains of NDI were used to assess disability related to C2 symptoms. METHODS: All patients who underwent posterior atlantoaxial stabilization via C1 lateral mass screw fixation at our institution over a two-year period were included in the study. Surgeons’ preference and training practices determined whether bilateral transection of the C2 nerve root was routinely performed, and was independent of underlying cervical pathology or anatomy. Data were prospectively collected on patient demographics, surgical variables and clinical outcome. A standard questionnaire was used to determine the presence, severity and frequency of posterior auricular numbness or pain, and its effect on quality of life. Domains of NDI were used to assess disability related to C2 symptoms.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
5. A Clinical Prediction Rule for Clinical Outcomes in Patients Undergoing Surgery for Degenerative Cervical Myelopathy: Analysis of an International AOSpine Prospective Multicenter Dataset of 771 Subjects Lindsay Tetreault1, Michael G. Fehlings, MD, PhD, FRCSC2, Branko Kopjar, MD, PhD3, Paul M. Arnold, MD4, Alexander R. Vaccaro, MD, PhD5, Eric M. Massicotte, MD, FRCSC6, Helton Luiz A. Defino, MD, PhD7, Giuseppe Barbagallo, MD8, Qiang Zhou9, Mehmet Zileli, MD10, Yasutsugu Yukawa, MD11, Massimo Scerrati, MD, PhD12, Tomoaki Toyone, MD, PhD13, Masato Tanaka, MD14, Christopher I. Shaffrey, MD15, Mark B. Dekutoski, MD16, Ziya L. Gokaslan, MD, FACS17, Christopher M. Bono, MD18; 1University Health Network, Toronto, ON, Canada; 2Toronto Western Hospital, Toronto, ON, Canada; 3Mercer Island, WA, US; 4 University of Kansas Medical Center, Department of Neurosurgery, Kansas City, KS, US; 5Rothman Institute, Philadelphia, PA, US; 6 University of Toronto, Toronto, ON, Canada; 7Universidade De Sao Paulo Faculdade De Medicina De Ribeirao Preto, Ribeirao Preto, SP, Brazil; 8 A.O.V. Policlinico, Catania, Italy; 9China; 10Izmir, Turkey; 11Chubu Rosai Hospital, Nagoya, Japan; 12Ancona, Marche, Italy; 13Teikyo University, Ichihara, Japan; 14Okayama, Japan; 15University of Virginia Department of Neurosurgery, Charlottesville, VA, US; 16The CORE Institute, Sun City West, AZ, US; 17Johns Hopkins University - Department of Neurosurgery, Baltimore, MD, US; 18Brigham & Women’s Hospital, Department of Orthopedic Surgery, Boston, MA, US BACKGROUND CONTEXT: Degenerative cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction worldwide. Surgery has been used for the treatment of CSM to arrest its progression, prevent further neurological disability and improve clinical status. However, it is often difficult to predict clinical outcomes in this heterogeneous patient population. PURPOSE: The objective of this study is to develop a clinical prediction rule relating the best combination of clinical variables to surgical outcome, based on data from two multicenter prospective studies STUDY DESIGN/SETTING: Prospective multicenter study. PATIENT SAMPLE: Two hundred and seventy-eight patients diagnosed with degenerative cervical myelopathy were enrolled in the CSM-North American study at 12 different sites. An additional 493 patients participated in the CSM-International study from sixteen different global sites. OUTCOME MEASURES: The modified Japanese Orthopaedic Association (mJOA) score at one-year follow-up was dichotomized: a successful outcome was defined as an mJOA greater than or equal to sixteen and a failed outcome was a score less than sixteen. METHODS: Multicollinearity of all variables was evaluated. Univariate analyses were performed to evaluate the relationship between outcome and various clinical predictors including signs and symptoms, gender, smoking status, baseline mJOA, duration of symptoms, age and co-morbidities. A set of important variables for the final model was selected based on author consensus and statistical findings. Logistic regression was used to formulate the final prediction model and assess the impact of each variable on outcome. RESULTS: Univariate analyses demonstrated the odds of a successful outcome decreased with the presence of certain symptoms, including clumsy hands (OR: 1.48, 95% CI: 1.01-2.18, p50.045), impaired gait (OR: 4.10, 95% CI: 2.64-6.36, p!0.001) and limb weakness (OR: 2.19, 95% CI: 1.403.44, p50.0007); the presence of certain signs, including corticospinal
3S
distribution motor deficits (OR: 2.26, 95% CI: 1.63-3.15, p!0.0001), upgoing plantar responses (OR: 1.61 95% CI: 1.16-2.24, p50.0041) and lower limb spasticity (OR: 1.79 95% CI: 1.30-2.47, p50.0004); smoking (OR: 0.67 95% CI: 0.47-0.96, p50.028); the presence of cardiovascular co-morbidities (OR: 0.45 95% CI 0.31-0.64 p!0.0001); a lower baseline mJOA score (OR: 1.37 95% CI 1.27-1.47, p!0.0001); and older age (OR: 0.96, 95% 0.95-0.98, p!0.0001). The final clinical prediction rule included age (OR: 0.97, 95%CI: 0.95-0.99, p50.0045), duration of symptoms (OR: 0.88, 95% CI: 0.76-1.01, p50.070), smoking status (OR: 0.66, 95%CI; 0.41-1.07, p50.093), impairment of gait (OR: 2.48, 95% CI: 1.44-4.27, p50.0011) cardiovascular co-morbidities (0.62, 95% CI: 0.41-0.95, p-0.030) and baseline severity score (OR: 1.26, 95% CI: 1.151.38, p!0.0001). The area under the receiver operator (ROC) curve was 0.77, indicating good model prediction. CONCLUSIONS: Based on this study, we have identified a list of the most important predictors of surgical outcome for CSM. Submitted on behalf of the CSM-North America and CSM-International study investigators. FDA DEVICE/DRUG STATUS: ProDisc-C (Approved for this indication), Prestige (Approved for this indication). http://dx.doi.org/10.1016/j.spinee.2013.07.036
6. Moved to The Spine Journal Outstanding Paper Awards and Editors’ Choice Award Presentations Session http://dx.doi.org/10.1016/j.spinee.2013.07.037
7. C2 Nerve Root Transection during C1 Lateral Mass Screw Fixation: Does it Affect Functionality and Quality of Life? Michael C. Dewan, MD1, Saniya S. Godil, MD1, Clinton J. Devin, MD2, Matthew J. McGirt, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US BACKGROUND CONTEXT: Posterior atlantoaxial stabilization via C1 lateral mass screw fixation can be technically challenging yet is an effective procedure for C1-2 instability. Sectioning of the C2 nerve root allows for direct visualization of the C1-2 joint and may facilitate arthrodesis of the C1-2 motion segment and accurate C1 screw placement. However, concern of posterior-auricular numbness often precludes C2 sectioning in routine practice. PURPOSE: We set out to determine the clinical and functional consequences of routine sectioning of C2 nerve root during placement of C1 lateral mass screws. STUDY DESIGN/SETTING: Prospective cohort study. PATIENT SAMPLE: All patients who underwent posterior atlantoaxial stabilization via C1 lateral mass screw fixation at our institution over a two-year period. OUTCOME MEASURES: A standard questionnaire was used to determine the presence, severity and frequency of posterior auricular numbness or pain, and its effect on quality of life. Domains of NDI were used to assess disability related to C2 symptoms. METHODS: All patients who underwent posterior atlantoaxial stabilization via C1 lateral mass screw fixation at our institution over a two-year period were included in the study. Surgeons’ preference and training practices determined whether bilateral transection of the C2 nerve root was routinely performed, and was independent of underlying cervical pathology or anatomy. Data were prospectively collected on patient demographics, surgical variables and clinical outcome. A standard questionnaire was used to determine the presence, severity and frequency of posterior auricular numbness or pain, and its effect on quality of life. Domains of NDI were used to assess disability related to C2 symptoms.
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.