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Study: Regional differences seen for CSM surgery despite procedure’s effectiveness

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SAN FRANCISCO — Results of the AOSpine multicenter, prospective CSM-I study showed scores on the modified Japanese Orthopaedic Association, Nurick and SF-36 Physical Component Summary and Mental Component Summary scales differed significantly from preoperative scores after surgery for cervical spondylotic myelopathy, and the differences were sometimes based on the region of the world in which the surgery was performed.

“In general, surgical treatment for degenerative cervical myelopathy is highly effective at all the clinics that participated in this study,” Michael G. Fehlings, MD, PhD, FRCSC, who presented the findings at the North American Spine Society Annual Meeting here, said.

Fehlings and other researchers, from 16 sites in all, examined the outcomes of 479 patients who underwent cervical spondylotic myelopathy (CSM) surgery. The researchers were able to follow-up about 81% of patients after 2 years, according to Fehlings.

“[This] is really quite remarkable when you consider that some of the sites were in India and South America. This is really a testament to the work of the various collaborators,” Fehlings, a Spine Surgery Today Editorial Board member, said.

The anterior approach was used in 58% of cases included in the study worldwide.

Patients’ ages at the time of CSM surgery differed by region, with patients in North America and Europe being older.

“In addition, the duration of symptoms tended to be longer in North America and Europe than the Asia-Pacific,” Fehlings said.

However, in terms of baseline modified Japanese Orthopaedic Association (mJOA) scores, neurological presentation was similar among regions, according to Fehlings.

At the 1-year follow-up, mJOA improvements from baseline were 2.25, 0.93, 1.45 and 2.47 points in Asia, Europe, Latin America and North America, respectively.

“There are some regional differences that we are trying to tease out, and these may partially reflect the differences in age that I have described; potentially socially cultural differences in how individuals perceive the impact of the disorder and the treatment,” Fehlings said. — by Susan M. Rapp

Reference:

Fehlings MG. Paper #24. Presented at: North American Spine Society Annual Meeting. Nov. 12-15, 2014; San Francisco.

Disclosure: Fehlings receives royalties from DePuy Spine, is a consultant to BioAxone and receives fellowship support from DePuy Spine that is paid directly to the institution/employer.