Predictors of outcome in patients with cervical spondylotic myelopathy undergoing surgical treatment: a survey of members from AOSpine International.
OBJECTIVE
To conduct a survey of the AOSpine community to determine international perceptions of key predictors of outcome in patients with cervical spondylotic myelopathy. This knowledge will guide the development of clinical prediction models and allow the alignment of clinical perceptions with evidence-based reality.


METHODS
A request to participate in a survey was distributed to members of AOSpine International. The primary question asked surgeons to rank eight clinical factors according to their ability to predict surgical outcome: age, preoperative severity, sex, duration of symptoms, smoking status, signs, and symptoms. Three questions were also included to address the importance of magnetic resonance imaging as a prognostic tool.


RESULTS
Six hundred and eighty-nine international spine professionals completed the survey, most of whom were spine surgeons. Duration of symptoms and baseline severity score were ranked as the top two predictors of outcome from all geographic locations, with the exception of Europe, which rated the presence of myelopathic symptoms more important than preoperative severity. There was international agreement that 65 years and a modified Japanese Orthopaedic Association score of 12 were the threshold age and preoperative severity above/below which there becomes a negative impact on outcome. Surgeons most frequently selected diabetes (n = 538) as the comorbidity having the most significant impact on surgical results, followed by neuromuscular disorders (n = 360). Finally, there was international consensus that magnetic resonance imaging is a valuable prognostic tool and that signal changes on T2- and T1/T2-weighted images are the most important parameters in outcome prediction.


CONCLUSIONS
This survey summarizes surgeons' perceptions of the most important predictors of outcome and provides insight into how surgeons undertake decision making.
Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
Lindsay A
LA
Tetreault
Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
Aria
A
Nouri
Toronto Western Hospital, Toronto, Ontario, Canada.
Anoushka
A
Singh
AOSpine International, Davos, Switzerland.
Mike
M
Fawcett
Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: Michael.fehlings@uhn.ca.
Michael G
MG
Fehlings
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D055009:Spondylosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome
AOSpine international; Baseline severity score; Cervical spondylotic myelopathy; Clinical factors; Combined T1/T2 signal changes; Duration of symptoms; Imaging factors; Predictors of surgical outcome; Signal intensity on t2-weighted images; Survey results