Do Racial Differences Affect Surgical Outcomes in Patients with Degenerative Cervical Myelopathy?: Results from the Prospective Multicenter AOSpine International Study on 479 Patients
Notice bibliographique
Résumé
Introduction Degenerative cervical myelopathy (DCM) is the most common disease of the cervical spine in the elderly worldwide, and surgical decompression is a widely accepted procedure to prevent neurological deterioration. Although racial background affects clinical outcomes in various medical conditions and diseases, few studies have evaluated the impact of racial differences on surgical outcome after DCM. The purpose of this study is to comprehensively evaluate whether racial background is an independent predictor of surgical outcomes for DCM. Material and Methods A total of 479 patients with symptomatic DCM were prospectively enrolled in the AOSpine CSM-International study at 16 global sites. Patients' functional status were evaluated using the modified Japanese Orthopedic Assessment scale, the Nurick score, the Neck Disability Index, and the Short- Form 36 (SF-36) Health Survey. Improvements in functional status and QOL were assessed between baseline and 24-months follow-up. A mixed model analytic approach was used to evaluate differences in surgical outcome between races, while controlling for relevant baseline characteristics and surgical factors. Results Of the 479 DCM patients, 324 (67.64%) and 106 (22.13%) were Caucasians and East Asians, respectively. Other races were excluded as there were too few patients to conduct separate analyses. There was no difference in the incidence of ossification of the posterior longitudinal ligament (OPLL) between the two races; however a greater percentage of Caucasians in India (46.15%) and Turkey (41.38%) exhibited OPLL than Caucasians at sites in other regions. The frequency of spondylosis was significantly higher in Caucasians ( p < 0.0001). Caucasians had a significantly longer duration of symptoms ( p = 0.0002), a greater number of co-morbidities ( p = 0.0288), and a lower preoperative score on the SF-36 Physical Component Score ( p = 0.0002) than East Asians. At 24-months postoperative, there were no significant differences in functional status or QOL between East Asian and Caucasian patients, after adjusting for variations in baseline characteristics, surgical preferences and disease causation. In addition, rates of perioperative complications were not significantly difference between the races ( p = 0.261). Conclusion Although the frequency of subcategories of DCM differs between racial backgrounds, this does not affect surgical outcomes for DCM. Decompressive surgery for DCM is equally safe, and provides comparable functional gains both in Caucasians and East Asians. Although the prevalence of OPLL in East Asians has generally been thought to be higher than amongst Caucasians, our findings indicate that individuals from India and Turkey may also be at a high risk of OPLL development.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».