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

Area of Science:

• Neurosurgery
• Spine Surgery
• Degenerative Spine Disease

Background:

• Multilevel degenerative cervical myelopathy presents complex surgical decision-making challenges.
• Accurate selection of the surgical approach is crucial for optimal patient outcomes.
• Existing methods may lack a standardized, objective framework for approach selection.

Purpose of the Study:

• To prospectively validate a novel decision-supporting coding system, the 7-letter code (7LC), for determining the surgical approach in multilevel degenerative cervical myelopathy.
• To assess the reliability and learning curve associated with the 7LC system among spine surgeons of varying experience levels.

Main Methods:

• Ten cases of multilevel degenerative cervical myelopathy were presented with clinical and imaging data.
• Senior and junior spine surgeons analyzed seven key parameters (e.g., spinal cord compression, C-spine alignment, K-line) to generate a 7LC.
• Surgeons performed two analyses per case, with interrater and intrarater reliability assessed using kappa statistics.

Main Results:

• Interrater reliability for junior surgeons significantly improved from the first to the second read (κ = 0.40 to κ = 0.76).
• Intrarater reliability was comparable between junior (κ = 0.78) and senior (κ = 0.71) surgeons.
• Agreement with the 7LC-suggested approach was substantial, with junior and senior surgeons showing high levels of complete or partial agreement.

Conclusions:

• The 7LC system demonstrated good overall reliability in guiding surgical approach selection for degenerative cervical myelopathy.
• Junior surgeons exhibited a learning curve, converging towards senior surgeon performance with repeated use of the 7LC.
• The 7LC provides a structured framework, aiding less experienced surgeons in analyzing critical parameters for surgical approach decision-making.