International Variations in Cervical Spondylotic Myelopathy

1. International Variations in the Clinical Presentation and Management of Cervical Spondylotic Myelopathy. One Year Outcomes of the AOSpine Multi-Center Prospective Study. Giuseppe Barbagallo, MD University of Catania, Catania, Italy On Behalf of the CSM-I Site Investigators : Michael Fehlings, MD, University of Toronto, Toronto, ON, Canada; Branko Kopjar, MD, University of Washington, Seattle, WA; Ronald Bartels, MD, University Nijmegen Medical Centre, Nijmegen, Netherlands; Vincenzo Albanese, PhD, Medical University of Catania, Catania, Italy; Helton Defino, MD, University of Sao Paulo - Ribeirao Preto, Sao Paulo, Brazil; Paul Arnold, MD, University of Kansas, Kansas City; Qiang Zhou, MD, Southwestern Hospital, ChongQing, China; Mehmet Zileli, MD, Ege University, Izmir, Turkey; Gamaliel Tan, MD, Tan Tock Seng Hospital, Singapore, Singapore; Osmar Moraes, MD, Hospital Santa Marcelina, Sao Paulo, Brazil; Shashank Kale, MD, All India Institute of Medical Sciences, New Dehli India; Ciaran Bolger, MD, Beaumont Hospital, Dublin, Ireland; Manuel Alvarado, MD, Hospital San Juan de Dios, Caracas, Venezuela; Massimo Scerrati, MD, Medical University of Ancona, Ancona, Italy

2. Background • Cervical spondyloticmyelopathy (CSM) is the commonest cause of spinal cord impairment. • There is a lack of evidence regarding the long term outcomes of surgical treatment for CSM. • We report on the one year outcomes of a large prospective multicenter study to evaluate the impact of surgery on outcomes of CSM.

3. Patients • 379 patients with clinically confirmed CSM and imaging evidence of cord compression (MRI or CT-myelogram) were enrolled in the prospective cohort study. Patients underwent anterior surgery (discectomy/corpectomy and instrumented fusion) or posterior surgery (laminectomy and fusion or laminoplasty) based on the judgment of the operating surgeon.

4. Subjects accounting • 379 subjects were enrolled at 13 sites around the world. • One year follow-up data are currently available for 193 subjects. • Outcomes evaluations • modified Japanese Orthopaedic Assessment scale (mJOA), Nurick Score, Neck Disability Index (NDI), Short Form-36v2, and an assessment of treatment complications.

5. Primary Investigators and Regions 125 121 81 52

6. Demographics

7. 12 months outcomes (N=193)

8. 12 months outcomes (N=193) - mJOA

9. Regional Differences in Demographics Regional Differences in Baseline Variables

10. Regional Differences in Outcomes *Values in table show changes in outcome between baseline and 12 months adjusted for baseline predictors. Numbers in parenthesis are standard error.

11. Discussion • Surgical treatment for CSM results in sustained improvement in generic and disease HRQOL • The amount of improvement varied across the regions. • Subjects from Asia & Pacific and Latin America had larger improvements in outcome than those from North America and Europe. • The impact of differences in age (much younger in Asia/Pacific) and socio-cultural perceptions of disability and impairment likely play a role in these observations

12. Acknowledgements • Study is funded by AOSpine International, a non-for-profit organization for excellence in spine.