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New model predicts operative outcomes in cervical spondylotic myelopathy
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NEW ORLEANS, USA — Using a new prediction model, surgeons could more accurately identify which patients undergoing surgery for cervical spondylotic myelopathy will have a successful outcome, according to results of a large, international prospective evaluation.
“The reason this will affect clinical practice is that knowledge of a patient’s outcome will not only provide decision support to surgeons, but will also enable surgeons to manage their patients’ expectation and provide appropriate counsel to their patients and families as to potential treatment options,” Lindsay Tetreault, BSc, of the University Health Network in Toronto, said.
“To date this is the largest evaluation of important predictors of surgical outcome in cervical spondylotic myelopathy (CSM). The key predictors in the original model were also very important,” she said.
Tetreault and colleagues developed their clinical prediction model using data from the prospective, multicenter AOSpine CSM-North America study. The model was externally validated using data from the prospective, multicenter AOSpine CSM-International study.
International validation important
“We wanted to validate this internationally because our original model truly reflects the culture, population characteristics and medical system of North America,” Tetreault said during her presentation. “There may exist certain international differences in demographics, disease presentation and surgical preference that could contribute to regional differences in patient prognosis.”
The sample included 272 patients enrolled in the CSM-North America study from 12 sites and 483 patients enrolled in the international study from 16 sites. All patients had symptomatic CSM and at least one clinical sign of myelopathy.
The original model demonstrated that a successful surgical outcome, defined as greater than or equal to 16 points on the modified Japanese Orthopaedic Association score, was best predicted by the lack of psychiatric disorders, specifically depression or bipolar; a higher baseline severity score; shorter duration of symptoms; lack of impaired gait; non-smoking status; and a younger age. This model displayed good external and geographic validity.
Combined dataset
The investigators refined their model using a combined North American and international dataset to create a global prediction rule that could be implemented in clinical practice.
Using data from 751 patients at 28 international sites, they found the same six predictors that were relevant in North America — age, duration of symptoms, baseline severity score, smoking and psychiatric status and impaired gait — were relevant on a global level.
There were important regional differences in the international dataset, according to Tetreault. The reported prevalence of psychiatric disorders was significantly lower in Europe, Asia-Pacific and Latin America and in the international dataset as a whole vs. the North American study. On average, the Asia-Pacific subsample was younger than the North American sample. Another difference in the study was that the duration of symptoms in patients in Latin America was longer than the CSM study, on average. – by Colleen Owens
- References:
- Tetreault L. Paper #5. Presented at: North American Spine Society Annual Meeting; Oct. 9-12, 2013; New Orleans, USA.
- Tetreault L. J Bone Joint Surg Am. 2013;doi:10.2106/JBJS.L.01323.
- For more information:
- Lindsay Tetreault, BSc, can be reached at 399 Bathurst St., Toronto, ON M5T 2S8, Canada; email: lindsay.tetreault@uhn.ca.
Disclosure: Tetreault has no relevant financial disclosures.