title: Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score.
abstract: BACKGROUND
  Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial.
  
  
  OBJECTIVE
  Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as good if the patient had mJOA score ≥16 and poor if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed.
  
  
  METHODS
  Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score.
  
  
  RESULTS
  Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5.
  
  
  CONCLUSIONS
  Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM.
authors.affiliation: Department of Orthopaedics, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.
authors.forename: Rishi Anil
authors.initials: RA
authors.lastname: Aggarwal
authors.affiliation: Department of Orthopaedics, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.
authors.forename: Sudhir Kumar
authors.initials: SK
authors.lastname: Srivastava
authors.affiliation: Department of Orthopaedics, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.
authors.forename: Sunil Krishna
authors.initials: SK
authors.lastname: Bhosale
authors.affiliation: Department of Orthopaedics, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India.
authors.forename: Pradip Sharad
authors.initials: PS
authors.lastname: Nemade
keywords: Compressive cervical myelopathy (CCM); predictors of the outcome; score; surgical outcome