PMID- 27246484
OWN - NLM
STAT- MEDLINE
DCOM- 20170224
LR  - 20170817
IS  - 1092-0684 (Electronic)
IS  - 1092-0684 (Linking)
VI  - 40
IP  - 6
DP  - 2016 Jun
TI  - Predicting the minimum clinically important difference in patients undergoing 
      surgery for the treatment of degenerative cervical myelopathy.
PG  - E14
LID - 10.3171/2016.3.FOCUS1665 [doi]
AB  - OBJECTIVE The minimum clinically important difference (MCID) is defined as the 
      minimum change in a measurement that a patient would identify as beneficial. 
      Before undergoing surgery, patients are likely to inquire about the ultimate 
      goals of the operation and of their chances of experiencing meaningful 
      improvements. The objective of this study was to define significant predictors of 
      achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale 
      at 2 years following surgery for the treatment of degenerative cervical 
      myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively 
      enrolled in either the AOSpine North America or International study at 26 global 
      sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were 
      excluded from this analysis (n = 743). Data were collected for each participating 
      subject, including demographic information, symptomatology, medical history, 
      causative pathology, and functional impairment. Univariate log-binominal 
      regression analyses were conducted to evaluate the association between 
      preoperative clinical factors and achieving an MCID on the mJOA scale. Modified 
      Poisson regression using robust error variances was used to create the final 
      multivariate model and compute the relative risk for each predictor. RESULTS The 
      sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age 
      of 56.48 +/- 11.85 years. At 2 years following surgery, patients exhibited a mean 
      change in functional status of 2.71 +/- 2.89 points on the mJOA scale. Of the 687 
      patients with available follow-up data, 481 (70.01%) exhibited meaningful gains 
      on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on 
      univariate analysis, significant predictors of achieving the MCID on the mJOA 
      scale were younger age; female sex; shorter duration of symptoms; nonsmoking 
      status; a lower comorbidity score and absence of cardiovascular disease; and 
      absence of upgoing plantar responses, lower-limb spasticity, and broad-based 
      unstable gait. The final model included age (relative risk [RR] 0.924, p < 
      0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 
      0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS 
      In this large multinational prospective cohort, 70% of patients treated 
      surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The 
      key predictors of achieving an MCID on the mJOA scale were younger age, shorter 
      duration of symptoms, nonsmoking status, and lack of significant gait impairment.
FAU - Tetreault, Lindsay
AU  - Tetreault L
AD  - Division of Neurosurgery, Toronto Western Hospital, University Health Network, 
      Toronto;
FAU - Wilson, Jefferson R
AU  - Wilson JR
AD  - Division of Neurosurgery, Toronto Western Hospital, University Health Network, 
      Toronto;
FAU - Kotter, Mark R N
AU  - Kotter MR
AD  - Division of Neurosurgery, Toronto Western Hospital, University Health Network, 
      Toronto;
FAU - Nouri, Aria
AU  - Nouri A
AD  - Division of Neurosurgery, Toronto Western Hospital, University Health Network, 
      Toronto;
FAU - Cote, Pierre
AU  - Cote P
AD  - University of Ontario Institute of Technology, Faculty of Health Sciences, 
      Oshawa, Ontario, Canada;
FAU - Kopjar, Branko
AU  - Kopjar B
AD  - Department of Health Services, School of Public Health, University of Washington, 
      Seattle, Washington; and.
FAU - Arnold, Paul M
AU  - Arnold PM
AD  - Department of Neurosurgery, University of Kansas, Kansas City, Kansas.
FAU - Fehlings, Michael G
AU  - Fehlings MG
AD  - Division of Neurosurgery, Toronto Western Hospital, University Health Network, 
      Toronto;
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Neurosurg Focus
JT  - Neurosurgical focus
JID - 100896471
SB  - IM
MH  - Adult
MH  - Aged
MH  - Analysis of Variance
MH  - Cohort Studies
MH  - Decompression, Surgical/*methods
MH  - Disability Evaluation
MH  - Female
MH  - Global Health
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Neurodegenerative Diseases/complications/*surgery
MH  - Predictive Value of Tests
MH  - Regression Analysis
MH  - Severity of Illness Index
MH  - Spinal Diseases/complications/*surgery
MH  - *Treatment Outcome
OTO - NOTNLM
OT  - DCM = degenerative cervical myelopathy
OT  - MCID
OT  - MCID = minimum clinically important difference
OT  - cervical spondylotic myelopathy
OT  - degenerative cervical myelopathy
OT  - mJOA = modified Japanese Orthopaedic Association
OT  - minimum clinically important difference
OT  - outcome prediction
OT  - surgical outcomes
EDAT- 2016/06/02 06:00
MHDA- 2017/02/25 06:00
CRDT- 2016/06/02 06:00
PHST- 2016/06/02 06:00 [entrez]
PHST- 2016/06/02 06:00 [pubmed]
PHST- 2017/02/25 06:00 [medline]
AID - 10.3171/2016.3.FOCUS1665 [doi]
PST - ppublish
SO  - Neurosurg Focus. 2016 Jun;40(6):E14. doi: 10.3171/2016.3.FOCUS1665.