Minimally invasive cervical laminectomy for spondylotic myelopathy in medically fragile patients
Bibliographic record
Abstract
BACKGROUND: Cervical spondylotic myelopathy often affects elderly and fragile patients who are not optimal candidates for major surgical procedures. Here, we report patients previously judged not suitable for cervical surgery, who were successfully treated with minimally invasive (MI) cervical decompressions without complications. METHODS: Retrospectively, we reviewed medically fragile patients (e.g., too many comorbidities), previously deemed unsuitable for surgery who successfully tolerated MI cervical decompressions. The accompanying preoperative comorbidities, surgical risks, complications, and neurological outcomes were assessed. RESULTS: Three male patients, with a mean age of 73 years, exhibited an average preoperative modified Japanese Orthopedic Association (mJOA) score of 8. The preoperative Charlson comorbidity indices, the Elixhauser comorbidity indices (respectively averaging 5.7 and 5.7 points, the preoperative Edmonton fragility index (average 12 points), and national surgical quality improvement program risks were calculated. Surgical times averaged 185 min and patients were followed for an average of 11.3 months. No patient had any immediate or delayed postoperative complications. The length of hospital stay was 1 day for each patient. The postoperative mJOA scores averaged 11, which was clinically significant. Further, the postoperative magnetic resonance imaging obtained approximately 3 months postoperative demonstrated adequate cord decompression. CONCLUSION: Medically fragile patients with significant cervical spondylotic myelopathy but major comorbidities precluding major surgery successfully underwent MI cervical decompressions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".