Geographical 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

Publication date: Available online 6 September 2017
Source:The Spine Journal
Author(s): Michael G. Fehlings, Branko Kopjar, Ahmed Ibrahim, Lindsay A. Tetreault, Paul M. Arnold, Helton Defino, Shashank Sharad Kale, S. Tim Yoon, Giuseppe M. Barbagallo, Ronald H.M. Bartels, Qiang Zhou, Alexander R. Vaccaro, Mehmet Zileli, Gamaliel Tan, Yasutsugu Yukawa, Darrel S. Brodke, Christopher I. Shaffrey, Osmar Santos de Moraes, Eric J. Woodard, Massimo Scerrati, Masato Tanaka, Tomoaki Toyone, Rick C. Sasso, Michael E. Janssen, Ziya L. Gokaslan, Manuel Alvarado, Ciaran Bolger, Christopher M. Bono, Mark B. Dekutoski
Background ContextDegenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. There is a paucity of studies reporting on regional variations in demographics, clinical presentation, disease causation and surgical effectiveness.PurposeTo evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay and complications across four geographic regions.Study Design/SettingMulticenter international prospective cohort study.Patient SampleA total of 757 symptomatic DCM patients undergoing surgical decompression of the cervical spine.Outcome MeasuresNeck Disability Index (NDI), Short Form 36 version 2 (SF36v2), modified Japanese Orthopaedic Association scale (mJOA), and Nurick grade.MethodsBaseline 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.ResultsPatients from Europe and North America were, on average, older than those from Latin America and Asia-Pacific (p=0.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<0.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalenet in Asia-Pacific (35.33%) and 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 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.ConclusionsThere are significant regional differences in demographics, causation and surgical approaches 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.



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