Cord compression defined by MRI is the driving factor behind the decision to operate in Degenerative Cervical Myelopathy despite poor correlation with disease severity
Autoři:
Bryn Hilton aff001; Jennifer Tempest-Mitchell aff001; Benjamin M. Davies aff002; Jibin Francis aff002; Richard J. Mannion aff002; Rikin Trivedi aff002; Ivan Timofeev aff002; John R. Crawford aff002; Douglas Hay aff002; Rodney J. Laing aff002; Peter J. Hutchinson aff002; Mark R. N. Kotter aff002
Působiště autorů:
School of Clinical Medicine, University of Cambridge, Cambridge, England, United Kingdom
aff001; Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, England, United Kingdom
aff002
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0226020
Souhrn
Objectives
The mainstay treatment for Degenerative Cervical Myelopathy (DCM) is surgical decompression. Not all cases, however, are suitable for surgery. Recent international guidelines advise surgery for moderate to severe disease as well as progressive mild disease. The goal of this study was to examine the factors in current practice that drive the decision to operate in DCM.
Study design
Retrospective cohort study.
Methods
1 year of cervical spine MRI scans (N = 1123) were reviewed to identify patients with DCM with sufficient clinical documentation (N = 39). Variables at surgical assessment were recorded: age, sex, clinical signs and symptoms of DCM, disease severity, and quantitative MRI measures of cord compression. Bivariate correlations were used to compare each variable with the decision to offer the patient an operation. Subsequent multivariable analysis incorporated all significant bivariate correlations.
Results
Of the 39 patients identified, 25 (64%) were offered an operation. The decision to operate was significantly associated with narrower non-pathological canal and cord diameters as well as cord compression ratio, explaining 50% of the variance. In a multivariable model, only cord compression ratio was significant (p = 0.017). Examination findings, symptoms, functional disability, disease severity, disease progression, and demographic factors were all non-significant.
Conclusions
Cord compression emerged as the main factor in surgical decision-making prior to the publication of recent guidelines. Newly identified predictors of post-operative outcome were not significantly associated with decision to operate.
Klíčová slova:
Decision making – Lesions – Magnetic resonance imaging – Spine – Surgeons – Surgical and invasive medical procedures – Treatment guidelines
Zdroje
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PLOS One
2019 Číslo 12
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