Regional Differences in Outcomes of Surgical Treatment for Cervical Spondylotic Myelopathy Outcomes of the AOSpine Multicenter Prospective CSM-I Study
Notice bibliographique
Résumé
Introduction Cervical spondylotic myelopathy (CSM) is a condition that is commonly seen in those over the age of 50 to 60 years. A progressive increase in the number of patients who present with CSM is expected in the coming decades as the proportion of those over 60 years is anticipated to double by 2050 according to the World Health Organization (WHO). Regional variations in the pattern of presentations, etiology, and surgical management of CSM are likely to be important determinants of outcome of treatment. Here, we report the current presentation and management of CSM in a large prospective international multicenter study (AOSpine CSM-International). Materials and Methods Between 2007 and 2011, all adult patients with imaging-confirmed CSM were enrolled at 16 international high-volume centers. Detailed data on presentation, treatment, and functional outcomes were collected prospectively. The decision on surgical approach, levels decompressed, and use of instrumentation was left to the attending surgeons. Patients with inflammatory, infective, or neoplastic myelopathic etiologies were excluded. Patients were followed-up for up to 24 months. Results Participating centers were based in Asia (AP, n = 150), Europe (E, n = 126), Latin (LA, n = 80), and North America (NA, n = 123). The mean age of the cohort was 56.4 years (range, 22–87 years) and majority of them were males. Patients from AP and LA were significantly younger (53.9 and 54.2 years, respectively) than those from NA and E ( p < 0.0003). The presenting underlying CSM pathology varied between regions ( p < 0.001). Posterior ligamentum flavum hypertrophy was most frequently seen in LA, and OPLL was prevalent in patients in AP (35%) and E (32%). Despite etiological variations, there were no differences in baseline mJOA, Nurick, and NDI scores ( p < 0.1). However, patients in AP scored the highest and those in LA scored the lowest on SF36 PCS, and LA patients had highest SF36 MCS scores ( p < 0.008). Anterior surgical decompression was performed in a majority in Europe (71.43%), AP (61.07%), and NA (56%) but not in LA (33%). Circumferential decompression surgery was rarely performed in NA (4.88%) and E (3.17%). At 24 months, there was significant improvement in overall outcome measures ( p < 0.001) in all regions. Patients in Asia demonstrated the greatest improvement in NDI and SF-36 PCS/MCS and patients in Europe the least. Patients from Europe had lower SF-36 QOL scores and showed less functional improvement in mJOA. NDI score was highest in the AP region. Conclusion There were significant regional variations in etiology of CSM but not at presenting functional status. Anterior cervical approach for CSM was the most common surgical approach worldwide. Surgical decompression achieved statistically significant improvements in mJOA, NDI, Nurick score, and SF36v2 across centers. However, there were variations in the degree of functional improvements gained across the regions.
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 | 0,002 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 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 ».