Geographic 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

• Published in: The spine journal 2018-04, Vol.18 (4), p.593-605
• Main Authors: Fehlings, Michael G., Kopjar, Branko, Ibrahim, Ahmed, Tetreault, Lindsay A., Arnold, Paul M., Defino, Helton, Kale, Shashank Sharad, Yoon, S. Tim, Barbagallo, Giuseppe M., Bartels, Ronald H.M., Zhou, Qiang, Vaccaro, Alexander R., Zileli, Mehmet, Tan, Gamaliel, Yukawa, Yasutsugu, Brodke, Darrel S., Shaffrey, Christopher I., Santos de Moraes, Osmar, Woodard, Eric J., Scerrati, Massimo, Tanaka, Masato, Toyone, Tomoaki, Sasso, Rick C., Janssen, Michael E., Gokaslan, Ziya L., Alvarado, Manuel, Bolger, Ciaran, Bono, Christopher M., Dekutoski, Mark B.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical Vertebrae - surgery; Decompression; Decompression, Surgical - adverse effects; Europe; Female; Geographic variation; Humans; Intervertebral Disc Displacement - epidemiology; Intervertebral Disc Displacement - pathology; Intervertebral Disc Displacement - surgery; Length of Stay - statistics & numerical data; Male; Middle Aged; Myelopathy; North America; Postoperative Complications - epidemiology; Postoperative Complications - pathology; Spinal Cord Diseases - epidemiology; Spinal Cord Diseases - pathology; Spinal Cord Diseases - surgery; Spondylosis - epidemiology; Spondylosis - pathology; Spondylosis - surgery; Surgical; Treatment efficacy; Treatment outcome
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2017.08.265

Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness. The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions. This is a multicenter international prospective cohort study. This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine. The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade. The baseline 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. Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p