Browsing by Author "Kopjar, B"
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Item Open Access Comparison of Outcomes between Anterior and Posterior Cervical Procedures: Results of Surgery Involving Four or More Vertebral Levels from the AOSpine North America Cervical Spondylotic Myelopathy Study(Global Spine Journal, 2015-01-01) Yoon, ST; Fehlings, M; Kopjar, B; Arnold, P; Massicotte, E; Vaccaro, A; Brodke, DS; Shaffrey, C; Woodard, E; Banco, R; Chapman, J; Janssen, M; Bono, C; Sasso, R; Dekutoski, M; Gokaslan, Z; Michael, KW; Thakur, N; Heller, JG; Rhee, JMIntroduction Debate continues about the relative merits of anterior versus posterior surgery for multilevel cervical stenosis causing myelopathy. Conclusions from previous studies were limited because one- or two-level anterior surgeries have been compared with multilevel posterior cases. The objective of this study was to compare outcomes and complications of anterior versus posterior-based cervical procedures (≥ 4 levels) for patients with multilevel disease. Material and Methods Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. A subset of patients with myelopathy involving four or five vertebrae was analyzed in this study. The outcome measures included NDI, modified-Japanese Orthopaedic Association scores, SF36v2, and Nurick grades. Adverse events were also collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days–2 years following surgery) were tabulated and stratified based on clinical factors. Results Of the 264 patients in the main study, 113 patients (42.8%) had four or more levels of surgery. There were 49 patients who underwent anterior cervical surgery (ACS, combination of anterior cervical decompression fusion ± corpectomy) and 64 patients who underwent posterior-based cervical surgeries (PCS, 45 laminectomy + fusion, 19 laminoplasty). There were statistically significant differences in age, cardiovascular comorbidities, and source of stenosis between these two groups. There was a statistically significant difference in baseline Nurick grades between groups (2.8 ACS vs. 3.3 PCS, p = 0.0075). There was no difference in any outcome measures at baseline. Outcome scores improved in both the ACS and PCS groups from baseline over a period of 2 years. There were no statistically significant differences between the anterior and posterior surgical procedures in terms of outcomes at 2 years ( p > 0.05). This was true for NDI, mJOA, SF36v2, and Nurick scores for both unadjusted and adjusted analyses. There was no significant difference in complication rates between ACS and PCS groups. Each group had 14 reported complications (total 28). Both the groups reported two postoperative C5 radiculopathies. There was one reoperation in the ACS group. Worsening of neck pain was reported in one patient who had an anterior corpectomy/fusion procedure and there was one case of infection in the PCS group. Two patients in the ACS group had worsening of myelopathy. Conclusion In patients with four or five involved vertebral levels of pathology that require surgical intervention for cervical myelopathy, both anterior and posterior surgical procedures demonstrate improved outcomes. With this dataset, we found no evidence of difference between anterior versus posterior surgical procedures in outcomes or associated complication rates. Surgical decision-making related to approach and technique to address issues in these patients can be made by surgeons based on their judgment and experience with these procedures. The limitations of this study include (1) a nonrandomized study design and (2) the grouping together of different subtypes of anterior or posterior procedures.Item Open Access Fehlings et al respond(Spine Journal, 2012-06-01) Fehlings, MG; Vaccaro, A; Wilson, JR; Kopjar, B; Harrop, JS; Aarabi, B; Shaffrey, CI; Dvorak, MF; Fisher, CG; Arnold, PM; Massicotte, EM; Lewis, SJ; Rampersaud, YRItem Open Access Geographic variations in clinical presentation and outcomes of decompressive surgery in patients with symptomatic degenerative cervical myelopathy: analysis of a prospective, international multicenter cohort study of 757 patients(Spine Journal, 2018-04-01) Fehlings, MG; Kopjar, B; Ibrahim, A; Tetreault, LA; Arnold, PM; Defino, H; Kale, SS; Yoon, ST; Barbagallo, GM; Bartels, RHM; Zhou, Q; Vaccaro, AR; Zileli, M; Tan, G; Yukawa, Y; Brodke, DS; Shaffrey, CI; Santos de Moraes, O; Woodard, EJ; Scerrati, M; Tanaka, M; Toyone, T; Sasso, RC; Janssen, ME; Gokaslan, ZL; Alvarado, M; Bolger, C; Bono, CM; Dekutoski, MBBackground Context: Degenerative cervical myelopathy (DCM) is a progressive degenerative spine disease and the most common cause of spinal cord impairment in adults worldwide. Few studies have reported on regional variations in demographics, clinical presentation, disease causation, and surgical effectiveness. Purpose: The objective of this study was to evaluate differences in demographics, causative pathology, management strategies, surgical outcomes, length of hospital stay, and complications across four geographic regions. Study Design/Setting: This is a multicenter international prospective cohort study. Patient Sample: This study includes a total of 757 symptomatic patients with DCM undergoing surgical decompression of the cervical spine. Outcome Measures: The outcome measures are the Neck Disability Index (NDI), the Short Form 36 version 2 (SF-36v2), the modified Japanese Orthopaedic Association (mJOA) scale, and the Nurick grade. Materials and Methods: The baseline characteristics, disease causation, surgical approaches, and outcomes at 12 and 24 months were compared among four regions: Europe, Asia Pacific, Latin America, and North America. Results: Patients from Europe and North America were, on average, older than those from Latin America and Asia Pacific (p=.0055). Patients from Latin America had a significantly longer duration of symptoms than those from the other three regions (p<.0001). The most frequent causes of myelopathy were spondylosis and disc herniation. Ossification of the posterior longitudinal ligament was most prevalent in Asia Pacific (35.33%) and in Europe (31.75%), and hypertrophy of the ligamentum flavum was most prevalent in Latin America (61.25%). Surgical approaches varied by region; the majority of cases in Europe (71.43%), Asia Pacific (60.67%), and North America (59.10%) were managed anteriorly, whereas the posterior approach was more common in Latin America (66.25%). At the 24-month follow-up, patients from North America and Asia Pacific exhibited greater improvements in mJOA and Nurick scores than those from Europe and Latin America. Patients from Asia Pacific and Latin America demonstrated the most improvement on the NDI and SF-36v2 PCS. The longest duration of hospital stay was in Asia Pacific (14.16 days), and the highest rate of complications (34.9%) was reported in Europe. Conclusions: Regional differences in demographics, causation, and surgical approaches are significant for patients with DCM. Despite these variations, surgical decompression for DCM appears effective in all regions. Observed differences in the extent of postoperative improvements among the regions should encourage the standardization of care across centers and the development of international guidelines for the management of DCM.