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Predictors of Surgical Outcome in Cervical Spondylotic Myelopathy

Karpova, Alina, MSc*,†; Arun, Ranganathan, DM, FRCS (Tr&Orth), PGDip (Orth Engin), MRCS*,†; Davis, Aileen M., PhD; Kulkarni, Abhaya V., MD, PhD§; Massicotte, Eric M., MD, MSc*,†; Mikulis, David J., BSc, MD; Lubina, Zvonimir I., MD; Fehlings, Michael G., MD, PhD, FRCSC*,**,††

doi: 10.1097/BRS.0b013e3182715bc3
Cervical Spine

Study Design. Prospective study.

Objective. To determine whether magnetic resonance imaging and clinical and demographic findings in patients with cervical spondylotic myelopathy (CSM) were independently associated with baseline functional scores and whether these were also predictive of postoperative functional outcomes.

Summary of Background Data. There are considerable limitations in current literature that prevent making formal recommendations regarding the use of clinical and radiological prognostic factors in patients with CSM.

Methods. This prospective study included 65 consecutive patients with CSM treated in a tertiary referral center. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify disability at admission and at 12-month follow-up. Age, sex, duration of symptoms, severity of myelopathy, spinal column alignment, surgical technique, levels of compression, anteroposterior diameter and transverse area at the site of maximal cord compression, and magnetic resonance imaging signal intensity changes were assessed. Data were analyzed using Spearman rank correlation test, analysis of variance, Mann–Whitney U test, and stepwise multivariate regression.

Results. Higher baseline mJOA scores were associated with younger age (P = 0.0002), shorter duration of symptoms (P = 0.03), and greater transverse area (P = 0.02). Better recovery ratio was associated with younger age (P = 0.005) and higher baseline mJOA score (P = 0.003). Greater changes in mJOA score were associated with higher baseline mJOA score (P < 0.0001). Using multivariate analysis, the functional outcomes after surgery were best predicted by baseline mJOA score and age of patient.

Conclusion. Age and baseline mJOA scores were highly predictive of outcome for patients undergoing surgical treatment of CSM. The degree of spinal cord compression and patterns of signal intensity changes on T1/T2 weighted images were not independently predictive of outcome, but it was found to correlate with the functional status at the time of presentation and age of the patient. The duration of symptoms correlated well with preoperative functional status but did not seem to affect the postoperative outcome.

A prospective study to establish the predictive value of magnetic resonance imaging and clinical and demographic findings for functional outcomes after surgery for cervical spondylotic myelopathy was conducted using statistical modeling. Age and clinical severity had direct correlation with functional outcome; however, symptom duration and degree of spinal cord compression did not.

*Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada

Toronto Western Hospital, University Health Network, University of Toronto, Ontario, Canada

Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network and Departments of Physical Therapy and Graduate Departments of Rehabilitation Science, Health Policy, Management and Evaluation and the Institute of Medical Science, University of Toronto, Toronto, Canada

§Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada

Department of Radiology, Division of Neuroradiology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

Department of Diagnostic and Interventional Radiology, University Hospital “Sestre milosrdnice,” University of Zagreb, Croatia

**Krembil Neuroscience Center, Toronto Western Hospital, Toronto, Ontario, Canada; and

††Halbert Chair in Neural Repair and Regeneration, Head, Spinal Program, University Health Network, Toronto, Ontario, Canada.

Address correspondence and reprint requests to Michael G. Fehlings, MD, PhD, FRCSC, Krembil Chair in Neural Repair and Regeneration, Toronto Western Hospital, University Health Network, Room 4W-449, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada; E-mail:

Acknowledgment date: February 9, 2012. First revision date: June 6, 2012. Second revision date: July 13, 2012. Third revision date: August 13, 2012. Acceptance date: August 18, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

AO Spine grant funds were received to support this work.

Relevant financial activities outside the submitted work: travel support, grants, patents, stocks.

© 2013 Lippincott Williams & Wilkins, Inc.