Distribution of Pathological Entities and Surgical Procedures Across Cervical Levels in Degenerative Cervical Myelopathy: An Exploratory Single-Center Analysis
4 affiliations
- 1Department of Neurosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
- 2Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
- 3Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale, Via Tesserete 46, 6900 Lugano, Switzerland
- 4Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
Abstract
Background/Objectives: Surgical planning in degenerative cervical myelopathy (DCM) considers the type of pathology, the number of levels involved, and cervical alignment and stability, but how the pathological entity, the operated level, and the procedure performed relate to one another remains unclear. This study described their distribution and associations in a consecutive surgical cohort. Methods: A total of 154 consecutive adults operated for DCM at a single center between 2013 and 2024 were studied retrospectively. Six non-mutually-exclusive pathological entities, five procedure types and every operated level (C2-C3 to T1-T2) were recorded, with combined procedures counted once. Associations were tested with Fisher–Freeman–Halton exact tests, with sensitivity analyses using a single dominant entity per patient and patient-level clustering, and a comparison of patients treated by ACDF alone versus any alternative strategy. Results: Procedure selection was related to the pathological entity (p < 0.001): isolated disc herniation was treated almost exclusively with ACDF (93.2%), whereas spondylolisthesis was the most heterogeneous, managed with posterior decompression and fixation (33.3%), ACCF (23.3%) or ACDF (23.3%); this persisted in the dominant-entity analysis (p = 0.002). The 46 patients (29.9%) not treated by ACDF alone were older, had more operated levels, worse baseline mJOA and more often circumferential compression (all p ≤ 0.005), whereas sagittal profile and cord and canal morphometry did not differ. Neither entities nor procedures were associated with the operated level across C3-C7 (p = 0.84 and p = 0.93); a nominally significant all-level result (p = 0.008) arose only from the sparsely operated terminal levels. Conclusions: Procedure selection in DCM was driven mainly by the underlying pathological entity, disease extent and compression geometry, rather than by the operated level or cervical alignment. No outcome data were analyzed, so these descriptive, hypothesis-generating findings require confirmation in larger multicenter cohorts with adequate representation of the terminal levels.
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BibTeX
@article{anselmi2026distribution,
title = {{Distribution of Pathological Entities and Surgical Procedures Across Cervical Levels in Degenerative Cervical Myelopathy: An Exploratory Single-Center Analysis}},
author = {Leonardo Anselmi and Gianpaolo Jannelli and Michele Da Broi and Aria Nouri and Nasser Bouhalassa and Federico Pessina and Enrico Tessitore},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218683},
url = {https://www.mdpi.com/2077-0383/15/21/8683},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Distribution of Pathological Entities and Surgical Procedures Across Cervical Levels in Degenerative Cervical Myelopathy: An Exploratory Single-Center Analysis
AU - Leonardo Anselmi
AU - Gianpaolo Jannelli
AU - Michele Da Broi
AU - Aria Nouri
AU - Nasser Bouhalassa
AU - Federico Pessina
AU - Enrico Tessitore
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218683
UR - https://www.mdpi.com/2077-0383/15/21/8683
AB - Background/Objectives: Surgical planning in degenerative cervical myelopathy (DCM) considers the type of pathology, the number of levels involved, and cervical alignment and stability, but how the pathological entity, the operated level, and the procedure performed relate to one another remains unclear. This study described their distribution and associations in a consecutive surgical cohort. Methods: A total of 154 consecutive adults operated for DCM at a single center between 2013 and 2024 were studied retrospectively. Six non-mutually-exclusive pathological entities, five procedure types and every operated level (C2-C3 to T1-T2) were recorded, with combined procedures counted once. Associations were tested with Fisher–Freeman–Halton exact tests, with sensitivity analyses using a single dominant entity per patient and patient-level clustering, and a comparison of patients treated by ACDF alone versus any alternative strategy. Results: Procedure selection was related to the pathological entity (p < 0.001): isolated disc herniation was treated almost exclusively with ACDF (93.2%), whereas spondylolisthesis was the most heterogeneous, managed with posterior decompression and fixation (33.3%), ACCF (23.3%) or ACDF (23.3%); this persisted in the dominant-entity analysis (p = 0.002). The 46 patients (29.9%) not treated by ACDF alone were older, had more operated levels, worse baseline mJOA and more often circumferential compression (all p ≤ 0.005), whereas sagittal profile and cord and canal morphometry did not differ. Neither entities nor procedures were associated with the operated level across C3-C7 (p = 0.84 and p = 0.93); a nominally significant all-level result (p = 0.008) arose only from the sparsely operated terminal levels. Conclusions: Procedure selection in DCM was driven mainly by the underlying pathological entity, disease extent and compression geometry, rather than by the operated level or cervical alignment. No outcome data were analyzed, so these descriptive, hypothesis-generating findings require confirmation in larger multicenter cohorts with adequate representation of the terminal levels.
SN - 2077-0383
ER -