| 1. |
- de Dios, Eddie, 1987, et al.
(författare)
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Comparison of the patient-derived modified Japanese Orthopaedic Association scale and the European myelopathy score
- 2024
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Ingår i: European Spine Journal. - : SPRINGER. - 0940-6719 .- 1432-0932. ; 33:3, s. 1205-1212
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the patient-derived modified Japanese Orthopaedic Association (P-mJOA) scale with the European myelopathy score (EMS) for the assessment of patients with degenerative cervical myelopathy (DCM). Methods: In this register-based cohort study with prospectively collected data, included patients were surgically treated for DCM and had reported both P-mJOA and EMS scores at baseline, 1-year follow-up, and/or 2-year follow-up to the Swedish Spine Register. P-mJOA and EMS scores were defined as severe (P-mJOA 0–11 and EMS 5–8), moderate (P-mJOA 12–14 and EMS 9–12), or mild (P-mJOA 15–18 and EMS 13–18). P-mJOA and EMS mean scores were compared, and agreement was evaluated with Spearman’s rank correlation coefficient (ρ), the intraclass correlation coefficient (ICC), and kappa (κ) statistics. Results: Included patients (n = 714, mean age 63.2years, 42.2% female) completed 937 pairs of the P-mJOA and the EMS. The mean P-mJOA and EMS scores were 13.9 ± 3.0 and 14.5 ± 2.7, respectively (mean difference –0.61 [95% CI –0.72 to –0.51; p < 0.001]). Spearman’s ρ was 0.84 (p < 0.001), and intra-rater agreement measured with ICC was 0.83 (p < 0.001). Agreement of severity level measured with unweighted and weighted κ was fair (κ = 0.22 [p < 0.001]; κ = 0.34 [p < 0.001], respectively). Severity levels were significantly higher using the P-mJOA (p < 0.001). Conclusion: The P-mJOA and the EMS had similar mean scores, and intra-rater agreement was high, whereas severity levels only demonstrated fair agreement. The EMS has a lower sensitivity for detecting severe myelopathy but shows an increasing agreement with the P-mJOA for milder disease severity. A larger interval to define severe myelopathy with the EMS is recommended.
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| 2. |
- de Dios, Eddie, 1987, et al.
(författare)
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Improvement rates, adverse events and predictors of clinical outcome following surgery for degenerative cervical myelopathy
- 2022
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 31:12, s. 3433-3442
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To investigate improvement rates, adverse events and predictors of clinical outcome after laminectomy alone (LAM) or laminectomy with instrumented fusion (LAM + F) for degenerative cervical myelopathy (DCM). Methods: This is a post hoc analysis of a previously published DCM cohort. Improvement rates for European myelopathy score (EMS) and Neck Disability Index (NDI) at 2- and 5-year follow-ups and adverse events are presented descriptively for available cases. Predictor endpoints were EMS and NDI scores at follow-ups, surgeon- and patient-reported complications, and reoperation-free interval. For predictors, univariate and multivariable models were fitted to imputed data. Results: Mean age of patients (LAM n = 412; LAM + F n = 305) was 68years, and 37.4% were women. LAM + F patients had more severe spondylolisthesis and less severe kyphosis at baseline, more surgeon-reported complications, more patient-reported complications, and more reoperations (p ≤ 0.05). After imputation, the overall EMS improvement rate was 43.8% at 2years and 36.3% at 5years. At follow-ups, worse EMS scores were independent predictors of worse EMS outcomes and older age and worse NDI scores were independent predictors of worse NDI outcomes. LAM + F was associated with more surgeon-reported complications (ratio 1.81; 95% CI 1.17–2.80; p = 0.008). More operated levels were associated with more patient-reported complications (ratio 1.12; 95% CI 1.02–1.22; p = 0.012) and a shorter reoperation-free interval (hazard ratio 1.30; 95% CI 1.08–1.58; p = 0.046). Conclusions: These findings suggest that surgical intervention at an earlier myelopathy stage might be beneficial and that less invasive procedures are preferable in this patient population.
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| 3. |
- de Dios, Eddie, 1987, et al.
(författare)
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MRI-based measurements of spondylolisthesis and kyphosis in degenerative cervical myelopathy.
- 2023
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Ingår i: BMC medical imaging. - : BioMed Central (BMC). - 1471-2342. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- To provide normative data and to determine accuracy and reliability of preoperative measurements of spondylolisthesis and kyphosis on supine static magnetic resonance imaging (MRI) of patients with degenerative cervical myelopathy.T2-weighted midsagittal images of the cervical spine were in 100 cases reviewed twice by one junior observer, with an interval of 3 months, and once by a senior observer. The spondylolisthesis slip (SSlip, mm) and the modified K-line interval (mK-line INT, mm) were assessed for accuracy with the standard error of measurement (SEm) and the minimum detectable change (MDC). Intraobserver and interobserver reliability levels were determined using the intraclass correlation coefficient (ICC).The SEm was 0.5mm (95% CI 0.4-0.6) for spondylolisthesis and 0.6mm (95% CI 0.5-0.7) for kyphosis. The MDC, i.e., the smallest difference between two examinations that can be detected with statistical certainty, was 1.5mm (95% CI 1.2-1.8) for spondylolisthesis and 1.6mm (95% CI 1.3-1.8) for kyphosis. The highest reliability levels were seen between the second observation of the junior examiner and the senior observer (ICC=0.80 [95% CI 0.70-0.87] and ICC=0.96 [95% CI 0.94-0.98] for SSlip and mK-line INT, respectively).This study provides normative values of alignment measurements of spondylolisthesis and kyphosis in DCM patients. It further shows the importance of taking measurement errors into account when defining cut-off values for cervical deformity parameters and their potential clinical application in surgical decision-making.
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| 4. |
- de Dios Perez, Eddie, 1987
(författare)
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Degenerative cervical myelopathy: Surgical treatment, imaging evaluation, and outcome
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord impairment in adults worldwide. The overall aims of this thesis were to compare patient-reported clinical outcomes, adverse events, and cost-effectiveness between decompression alone and decompression with fusion; evaluate magnetic resonance imaging (MRI)-based sagittal alignment measurements; determine postoperative improvement rates and potential predictors of surgical outcome; and compare the patient-derived modified Japanese Orthopaedic Association (P-mJOA) scale with the European Myelopathy Score (EMS) for the assessment of DCM. Through five papers based on three patient cohorts, patients surgically treated for DCM were assessed using prospectively collected data from the national Swedish Spine Register and preoperative MRI examinations. In paper I, laminectomy alone (LAM) was not associated with inferior clinical outcomes 5 years postoperatively compared with laminectomy plus fusion (LAM+F). For each propensity score-matched patient treated with fusion, the cost increase was estimated to $4,700 US, without any observed benefit regarding long-term efficacy, complications, or reoperation rates. In paper II, muscle-preserving selective laminectomy (SL) provided similar clinical improvement 2 years postoperatively compared with anterior decompression and fusion. Reoperation rates were similar, but SL was associated with significantly fewer overall complications and fewer serious adverse events, as well as higher cost-effectiveness. In paper III, spondylolisthesis and kyphosis measurements on supine static MRI were measured with high interobserver reliability. In paper IV, improvement rates 2 years and 5 years after LAM or LAM+F were approximately 40%. More severe baseline myelopathy, older age, treatment with LAM+F, and more operated levels were predictors of worse surgical outcome. In paper V, the P-mJOA and the EMS had similar mean scores, and varying intra-rater agreement levels, ranging from ‘fair’ to ‘high’. Compared with the P-mJOA, the EMS has a low sensitivity for detecting severe myelopathy but shows an increasing agreement with the P-mJOA for milder disease severity. In conclusion, laminectomy techniques and fusion techniques offer comparable clinical outcomes. Laminectomy with muscle-preservation might however be safer and more cost-effective. Despite high interobserver reliability, MRI-based sagittal alignment measurements may be misleading if measurement errors are not adequately considered when defining narrow surgical criteria. The predictor analysis suggests that intervention at an earlier myelopathy stage might be beneficial. Finally, the continued use of the P-mJOA as a patient-reported, gold standard assessment tool for DCM is recommended.
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