Comparison of outcomes after anterior versus posterior surgery for degenerative cervical myelopathy: a pooled analysis of individual patient data
Bibliographic record
Abstract
BACKGROUND CONTEXT: Uncertainty exists regarding the optimal surgical approach to treat patients with degenerative cervical myelopathy (DCM). This uncertainty is particularly marked for patients with mild DCM who may be more sensitive to different management techniques. PURPOSE: To determine the effect of surgical approach on one-year outcomes for DCM. STUDY DESIGN/SETTING: Individual patient data meta-analysis of 3 independent, prospective, multicentre clinical trials (ie, CSM-North America, CSM-International, CSM-Protect) that enrolled patients between 2005 and 2018 in academic hospitals, with 1 yr follow up. Statistical analysis was performed from September 13, 2023 to April 2, 2024. PATIENT SAMPLE: From a total of 1047 adult subjects with DCM, 980 met the eligibility criteria who were surgical candidates with symptomatic and radiologically-evidenced DCM with no prior cervical surgery. OUTCOMES MEASURES: The primary endpoint was change in 36-Item Short Form Health Survey Physical Component Summary score (SF36-PCS; minimum clinically important difference [MCID]=4) at 1 yr compared to preoperatively. Secondary endpoints were change in modified Japanese Orthopedic Association (mJOA; MCID=2) score, Neck Disability Index (NDI; MCID=15) score, SF36 Mental Component Summary (SF36-MCS; MCID=4) score, and postoperative complications. METHODS: Two comparison cohorts were created: i) anterior surgery and ii) posterior surgery. Mean differences (MD) of outcomes with 95% confidence intervals (CI) were estimated using one-stage covariate-adjusted hierarchical mixed-effects meta-analyses with study and treatment exposure as random effects. A priori subgroup analysis in mild DCM patients (mJOA=15-17) was conducted. RESULTS: The mean patient age was 56.9 years (SD=11.4), with 38.7% that identified as female. 560 patients (57.1%) received anterior cervical decompressive surgery for DCM. Patients who had anterior decompressive surgery experienced greater improvements in quality of life and disability at 1 yr follow-up than those who underwent posterior decompressive surgery in SF36-PCS (MD=1.57 [95% CI 0.11-3.03], p=.0348) and NDI (MD=3.32 [95% CI 0.58-6.05], p=.017). Dysphagia was more likely after anterior surgery. Pseudoarthrosis and wound infections were more likely after posterior surgery. In a subgroup of patients with mild DCM, patients who underwent anterior decompressive surgery experienced even greater improvements in SF36-PCS (MD=5.45 [95% CI 1.73-9.18], p=.0042), NDI (MD=10.37 [95%CI 3.43-17.31], p=.0035), and mJOA (MD=0.95 [95% CI 0.12-1.77], p=.0238; MCID=1) than posterior surgery patients. CONCLUSION: Anterior surgical decompression for DCM is associated with greater improvements in 1 yr patient-reported quality of life and disability than posterior surgical decompression. These results may assist clinicians in driving complex management decisions.
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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 | 0.018 | 0.033 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.010 | 0.022 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".