title: A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients.
abstract: METHODS
  Prospective, multicenter international cohort.
  
  
  OBJECTIVE
  To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level.
  
  
  BACKGROUND
  CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM to improve neurological and functional status and quality of life. The outcomes of surgical intervention for CSM have never been evaluated at an international level.
  
  
  METHODS
  Between October 2007 and January 2011, 479 symptomatic patients with image evidence of CSM were enrolled in the prospective, multicenter AOSpine CSM-International study from 16 global sites. Preoperative and postoperative clinical status, functional impairment, and quality of life were evaluated using the modified Japanese Orthopaedic Assessment Scale, Nurick Scale, Neck Disability Index, and Short-Form-36v2. Preoperative and 12- and 24-month postoperative outcomes were compared using mixed-model analysis of covariance for repeated measurements.
  
  
  RESULTS
  The study cohort consisted of 310 males and 169 females, with a mean age of 56.37 ± 11.91 years. There were significant differences in age, etiology, and surgical approaches between the regions. At 24 months postoperatively, the mean modified Japanese Orthopaedic Assessment Scale score improved from 12.50 (95% confidence interval [CI], 12.24-12.76) to 14.90 (95% CI, 14.64-15.16); the Neck Disability Index improved from 36.38 (95% CI, 34.33-38.43) to 23.20 (95% CI, 21.24-25.15); and the SF36v2 Physical Component Score and Mental Composite Score improved from 34.28 (95% CI, 33.46-35.10) to 40.76 (95% CI, 39.71-41.81) and 39.45 (95% CI, 38.25-40.64) to 46.24 (95% CI, 44.94-47.55), respectively. The rate of neurological complications was 3.13%.
  
  
  CONCLUSIONS
  Surgical decompression for CSM is safe and results in improved functional status and quality of life in patients around the world, irrespective of differences in medical systems and sociocultural determinants of health.
  
  
  METHODS
  3.
authors.affiliation: *Department of Surgery, University of Toronto, Toronto, Ontario, Canada †Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada ‡Department of Neurosurgery, University Hospital Catania, Catania, Italy §Hospital San Juan de Dios, Caracas, Venezuela ¶Department Neurosurgery, The University of Kansas, Kansas City ‖Department of Neurosurgery Radboud University, Nijmegen Medical Centre; Nijmegen, the Netherlands **Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland ††Faculty of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil ‡‡Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India §§Department of Neurosurgery, Hospital Santa Marcelina, Santa Marcelina, Brazil ¶¶Department of Neurosurgery, Università Politecnica Delle Marche, Ancona, Italy ‖‖Department of Orthopaedics, Tan Tock Seng Hospital, Singapore, Singapore ***Department of Orthopedic Surgery, Okayama University, Okayama, Japan †††Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan ‡‡‡Department of Orthopaedic Surgery, Chubu Rosai Hospital, Nagoya, Japan §§§Department of Orthopedics, Third Military Medical University, Chongqing, China ¶¶¶Department of Neurosurgery, Ege University, Izmir, Turkey; and ‖‖‖Department of Health Services, University of Washington, Seattle.
authors.forename: Michael G
authors.initials: MG
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mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D013118:Spinal Cord Diseases / Q000601:surgery*; D013128:Spinal Osteophytosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult