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dc.contributor.authorHilton, Bryn
dc.contributor.authorTempest-Mitchell, Jennifer
dc.contributor.authorDavies, Benjamin M.
dc.contributor.authorFrancis, Jibin
dc.contributor.authorMannion, Richard J.
dc.contributor.authorTrivedi, Rikin
dc.contributor.authorTimofeev, Ivan
dc.contributor.authorCrawford, John R.
dc.contributor.authorHay, Douglas
dc.contributor.authorLaing, Rodney J.
dc.contributor.authorHutchinson, Peter J.
dc.contributor.authorKotter, Mark R. N.
dc.date.accessioned2019-12-27T04:07:38Z
dc.date.available2019-12-27T04:07:38Z
dc.date.issued2019-12-26
dc.date.submitted2019-06-30
dc.identifier.otherpone-d-19-18443
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/300260
dc.description.abstractObjectives: 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.
dc.languageen
dc.subjectResearch Article
dc.subjectMedicine and health sciences
dc.subjectResearch and analysis methods
dc.subjectBiology and life sciences
dc.subjectPeople and places
dc.subjectSocial sciences
dc.titleCord compression defined by MRI is the driving factor behind the decision to operate in Degenerative Cervical Myelopathy despite poor correlation with disease severity
dc.typeArticle
dc.date.updated2019-12-27T04:07:37Z
dc.identifier.doi10.17863/CAM.47333
dcterms.dateAccepted2019-11-17
rioxxterms.versionofrecord10.1371/journal.pone.0226020
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by/4.0/
datacite.contributor.supervisoreditor: Farag, Ehab
dc.contributor.orcidHilton, Bryn [0000-0001-9617-6753]
dc.identifier.eissn1932-6203
pubs.funder-project-idNational Institute for Health Research (CS-2015-15-023)


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