PMID- 32276258 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240517 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 33 IP - 2 DP - 2020 Apr 10 TI - Clinical predictors of achieving the minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research Network. PG - 129-137 LID - 10.3171/2020.2.SPINE191495 [doi] AB - OBJECTIVE: Recently identified prognostic variables among patients undergoing surgery for cervical spondylotic myelopathy (CSM) are limited to two large international data sets. To optimally inform shared clinical decision-making, the authors evaluated which preoperative clinical factors are significantly associated with improvement on the modified Japanese Orthopaedic Association (mJOA) scale by at least the minimum clinically important difference (MCID) 12 months after surgery, among patients from the Canadian Spine Outcomes and Research Network (CSORN). METHODS: The authors performed an observational cohort study with data that were prospectively collected from CSM patients at 7 centers between 2015 and 2017. Candidate variables were tested using univariable and multiple binomial logistic regression, and multiple sensitivity analyses were performed to test assumptions about the nature of the statistical models. Validated mJOA MCIDs were implemented that varied according to baseline CSM severity. RESULTS: Among 205 patients with CSM, there were 64 (31%) classified as mild, 86 (42%) as moderate, and 55 (27%) as severe. Overall, 52% of patients achieved MCID and the mean change in mJOA score at 12 months after surgery was 1.7 +/- 2.6 points (p < 0.01), but the subgroup of patients with mild CSM did not significantly improve (mean change 0.1 +/- 1.9 points, p = 0.8). Univariate analyses failed to identify significant associations between achieving MCID and sex, BMI, living status, education, smoking, disability claims, or number of comorbidities. After adjustment for potential confounders, the odds of achieving MCID were significantly reduced with older age (OR 0.7 per decade, 95% CI 0.5-0.9, p < 0.01) and higher baseline mJOA score (OR 0.8 per point, 95% CI 0.7-0.9, p < 0.01). The effects of symptom duration (OR 1.0 per additional month, 95% CI 0.9-1.0, p = 0.2) and smoking (OR 0.4, 95% CI 0.2-1.0, p = 0.06) were not statistically significant. CONCLUSIONS: Surgery is effective at halting the progression of functional decline with CSM, and approximately half of all patients achieve the MCID. Data from the CSORN confirmed that older age is independently associated with poorer outcomes, but novel findings include that patients with milder CSM did not experience meaningful improvement, and that symptom duration and smoking were not important. These findings support a nuanced approach to shared decision-making that acknowledges some prognostic uncertainty when weighing the various risks, benefits, and alternatives to surgical treatment. FAU - Evaniew, Nathan AU - Evaniew N AD - 1University of Calgary Spine Program, University of Calgary, Alberta. FAU - Cadotte, David W AU - Cadotte DW AD - 1University of Calgary Spine Program, University of Calgary, Alberta. FAU - Dea, Nicolas AU - Dea N AD - 2Vancouver Spine Surgery Institute, University of British Columba, Vancouver, British Columbia. FAU - Bailey, Christopher S AU - Bailey CS AD - 3Department of Surgery, Western University, London, Ontario. FAU - Christie, Sean D AU - Christie SD AD - 4Department of Surgery, Dalhousie University, Halifax, Nova Scotia. FAU - Fisher, Charles G AU - Fisher CG AD - 2Vancouver Spine Surgery Institute, University of British Columba, Vancouver, British Columbia. FAU - Paquet, Jerome AU - Paquet J AD - 5Departement de chirurgie, Universite Laval, Quebec. FAU - Soroceanu, Alex AU - Soroceanu A AD - 1University of Calgary Spine Program, University of Calgary, Alberta. FAU - Thomas, Kenneth C AU - Thomas KC AD - 1University of Calgary Spine Program, University of Calgary, Alberta. FAU - Rampersaud, Y Raja AU - Rampersaud YR AD - 6Department of Surgery, University of Toronto, Ontario. FAU - Manson, Neil A AU - Manson NA AD - 4Department of Surgery, Dalhousie University, Halifax, Nova Scotia. AD - 7Canada East Spine Centre, Saint John, New Brunswick. FAU - Johnson, Michael AU - Johnson M AD - 8Department of Surgery, University of Manitoba, Winnipeg, Manitoba. FAU - Nataraj, Andrew AU - Nataraj A AD - 9Department of Surgery, University of Alberta, Edmonton, Alberta; and. FAU - Hall, Hamilton AU - Hall H AD - 6Department of Surgery, University of Toronto, Ontario. FAU - McIntosh, Greg AU - McIntosh G AD - 10Canadian Spine Outcomes and Research Network, Markdale, Ontario, Canada. FAU - Jacobs, W Bradley AU - Jacobs WB AD - 1University of Calgary Spine Program, University of Calgary, Alberta. LA - eng PT - Journal Article DEP - 20200410 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - cervical OT - myelopathy OT - outcomes OT - predictors OT - spine OT - surgery EDAT- 2020/04/11 06:00 MHDA- 2020/04/11 06:01 CRDT- 2020/04/11 06:00 PHST- 2019/12/15 00:00 [received] PHST- 2020/02/18 00:00 [accepted] PHST- 2020/04/11 06:01 [medline] PHST- 2020/04/11 06:00 [pubmed] PHST- 2020/04/11 06:00 [entrez] AID - 2020.2.SPINE191495 [pii] AID - 10.3171/2020.2.SPINE191495 [doi] PST - epublish SO - J Neurosurg Spine. 2020 Apr 10;33(2):129-137. doi: 10.3171/2020.2.SPINE191495.