Outcome of Patients With Mild Degenerative Cervical Myelopathy Treated Nonoperatively: An Observational Study From the Canadian Spine Outcome and Research Network
Bibliographic record
Abstract
BACKGROUND AND OBJECTIVES: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. The natural history of mild DCM is not fully understood, and both operative and nonoperative strategies have been proposed as treatment modalities. The aim of this study was to analyze the outcome of patients with mild DCM treated nonoperatively and identify risk factors for neurological deterioration and conversion to surgery. METHODS: All patients with mild DCM (modified Japanese Orthopaedic Association [mJOA] score 15-17), enrolled between 2015 and 2023, who were initially treated nonoperatively, as part of an ongoing prospective, multicenter observational cohort study were included. Neurological function (mJOA), patient-reported outcomes (neck disability index, EuroQol-5D, short form-12, numeric rating scale [NRS]), and radiographic findings at enrollment and 1 year were assessed. Progression of disease was defined as neurological deterioration by ≥2 mJOA. Conversion to surgery was a secondary end point. RESULTS: One hundred forty patients with mild DCM were initially treated nonoperatively. The mean mJOA score was 16.8 ± 0.8, with no clinically significant change after 1 year (16.5 ± 1.3; P = .031). Improved EuroQol-5D, relief in the NRS arm, and neck pain below the minimal clinically important difference level were noted after 1 year. A drop of ≥2 mJOA points occurred in 13.3% (n = 14). Seventeen patients (12.1%) crossed over to surgical treatment at an average time of 3.4 years. Patients who crossed over had lower baseline mJOA scores (16.2 ± 1.0 vs 16.7 ± 0.9; P = .03), but otherwise comparable patient-reported outcomes at baseline ( P > .05). Delayed surgery improved NRS neck pain (5.0 ± 3.1 vs 1.9 ± 1.4; P = .02). CONCLUSION: Neurological deterioration or the need for surgery is relatively uncommon in patients with conservatively treated mild DCM. A deterioration rate of 13.3% at 1 year and a conversion rate of 12.1% over 3.4 years with no clear risk factors were noted. Crossover patients presented with worse mJOA. No other clinically significant parameter was found to be a risk factor for neurological deterioration nor a driver for crossover.
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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 | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| 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".