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

TitleDegenerative Cervical Myelopathy: A 7-Letter Coding System That Supports Decision-Making for the Surgical Approach.
Publication TypeJournal Article
Year of Publication2020
AuthorsPapavero L, Schmeiser G, Kothe R, Boszczyk B, Heese O, Kawaguchi Y, MacDowall A, Olerud C, Paidakakos N, Panagiotou A, Pitzen T, Richter M, K Riew D, Stevenson A, Tan L, Ueshima R, Yau YH, Mayer M
Date Published2020 Mar

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.

Alternate JournalNeurospine
PubMed ID31284334
PubMed Central IDPMC7136109
Grant List / / Deutsche Arthrose-Hilfe e.V /