Degenerative Cervical Myelopathy: A 7-Letter Coding System That Supports Decision-Making for the Surgical Approach

다국어 초록 (Multilingual Abstract)

Objective: To validate with a prospective study a decision-supporting coding system for the surgical approach for multilevel degenerative cervical myelopathy. Methods: Ten cases were presented on an internet platform, including clinical and imaging data. A single-approach (G1), a choice between 2 (G2), or 3 approaches (G3) were options. Senior and junior spine surgeons analyzed 7 parameters: location and extension of the compression of the spinal cord, C-spine alignment and instability, general morbidity and bone diseases, and K-line and multilevel corpectomy. For each parameter, an anterior, posterior, or combined approach was suggested. The most frequent letter or the last letter (if C) of the resulting 7-letter code (7LC) suggested the surgical approach. Each surgeon performed 2 reads per case within 8 weeks. Results: G1: Interrater reliability between junior surgeons improved from the first read (κ=0.40) to the second (κ=0.76, p<0.001) but did not change between senior surgeons (κ=0.85). The intrarater reliability was similar for junior (κ=0.78) and senior (κ=0.71) surgeons. G2: Junior/senior surgeons agreed completely (58%/62%), partially (24%/23%), or did not agree (18%/15%) with the 7LC choice. G3: junior/senior surgeons agreed completely (50%/50%) or partially (50%/50%) with the 7LC choice. Conclusion: The 7LC showed good overall reliability. Junior surgeons went through a learning curve and converged to senior surgeons in the second read. The 7LC helps less experienced surgeons to analyze, in a structured manner, the relevant clinical and imaging parameters influencing the choice of the surgical approach, rather than simply pointing out the only correct one.

참고문헌 (Reference)

1 Cohen J, "Weighted kappa : nominal scale agreement with provision for scaled disagreement or partial credit" 70 : 213-220, 1968

2 Irwin ZN, "Variation in surgical decision making for degenerative spinal disorders. Part II: cervical spine" 30 : 2214-2219, 2005

3 Epstein JA, "The surgical management of cervical spinal stenosis, spondylosis, and myeloradiculopathy by means of the posterior approach" 13 : 864-869, 1988

4 Landis JR, "The measurement of observer agreement for categorical data" 33 : 159-174, 1977

5 Aryan HE, "Successful treatment of cervical myelopathy with minimal morbidity by circumferential decompression and fusion" 16 : 1401-1409, 2007

6 Sevki K, "Results of surgical treatment for degenerative cervical myelopathy: anterior cervical corpectomy and stabilization" 29 : 2493-2500, 2004

7 Dante Leven, "Pseudarthrosis of the Cervical Spine: Risk Factors, Diagnosis and Management" 대한척추외과학회 10 (10): 776-786, 2016

8 Light RJ, "Measures of response agreement for qualitative data : some generalizations and alternatives" 76 : 365-377, 1971

9 Fehlings MG, "Is surgery for cervical spondylotic myelopathy cost-effective? A cost-utility analysis based on data from the AOSpine North America prospective CSM study" 17 (17): 89-93, 2012

10 Gamer M, "Irr: various coefficients of interrater reliability and agreement. R package ver. 0.5"

11 Nouri A, "Influence of magnetic resonance imaging features on surgical decision-making in degenerative cervical myelopathy : results from a global survey of AOSpine International Members" 105 : 864-874, 2017

12 Bakhsheshian J, "Current diagnosis and management of cervical spondylotic myelopathy" 7 : 572-586, 2017

13 Hallgren KA, "Computing inter-rater reliability for observational data : an overview and tutorial" 8 : 23-34, 2012

14 Luo J, "Comparison of anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy" 24 : 1621-1630, 2015

15 Kato S, "Comparison of anterior and posterior surgery for degenerative cervical myelopathy : an MRI-based propensity-score-matched analysis using data from the prospective multicenter AOSpine CSM North America and International Studies" 99 : 1013-1021, 2017

16 Uribe JS, "Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction : analysis of outcome and long-term follow-up" 18 : 654-662, 2009

17 Ghogawala Z, "Comparative effectiveness of ventral vs dorsal surgery for cervical spondylotic myelopathy" 68 : 622-630, 2011

18 Naderi S, "Cervical spondylotic myelopathy : surgical decision making" 1 : e1-, 1996

19 Hartmann S, "Cervical corpectomies:results of a survey and review of the literature on diagnosis, indications, and surgical technique" 158 : 1859-1867, 2016

20 Singh K, "Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine" 28 : 2352-2358, 2003

21 Fehlings MG, "Anterior versus posterior surgical approaches to treat cervical spondylotic myelopathy:outcomes of the prospective multicenter AOSpine North America CSM study in 264 patients" 38 : 2247-2252, 2013

22 Lawrence BD, "Anterior versus posterior approach for treatment of cervical spondylotic myelopathy : a systematic review" 38 (38): S173-S182, 2013

23 Herdmann J, "Advances in neurosurgery" Springer 266-268, 1994

24 Hackett NJ, "ASA class is a reliable independent predictor of medical complications and mortality following surgery" 18 : 184-190, 2015

25 Finn RH, "A note on estimating the reliability of categorical data" 30 : 71-76, 1970

26 Fujiyoshi T, "A new concept for making decisions regarding the surgical approach for cervical ossification of the posterior longitudinal ligament: the Kline" 33 : E990-E993, 2008

27 Koller H, "4-and 5-level anterior fusions of the cervical spine : review of literature and clinical results" 16 : 2055-2071, 2007