{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:04:59Z","timestamp":1780131899304,"version":"3.54.0"},"reference-count":90,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Cervical spondylotic myelopathy (CSM) is a common cause of spinal cord dysfunction worldwide and can be treated through anterior or posterior approaches. Both strategies achieve acceptable results, but the growing prevalence of obesity poses unique challenges. Data directly comparing outcomes across body mass index (BMI) strata are limited. Here, the authors examined rates of achieving minimal clinically important differences (MCIDs) in patient-reported outcomes (PROs) between anterior and posterior approaches relative to BMI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      This was a post hoc analysis of prospectively collected data from the 14-site Spine CORe\u2122 study group of the Quality Outcomes Database (QOD). Baseline data and PROs\u2014including numeric rating scale (NRS) neck and arm pain, Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scores\u2014were collected through 60 months. Patients were stratified by an a priori BMI threshold of 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and by surgical approach (anterior vs posterior). Multivariable regression was used to compare achievement of MCID across approaches within each BMI group. In parallel, unsupervised clustering of baseline-adjusted PROs was combined with a doubly robust estimation framework to assess approach-specific probabilities of achieving optimal outcomes across the continuous BMI spectrum.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Among 1085 patients, 759 (70.0%) underwent anterior and 326 (30.0%) underwent posterior surgery. Anterior approaches were associated with shorter length of stay and fewer nonhome discharges (p &lt; 0.001). For patients with BMI &lt; 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , anterior surgery conferred higher odds of achieving MCID in NRS arm pain (OR 0.45, p = 0.032). For those with BMI \u2265 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , anterior surgery was associated with greater odds of achieving MCID in mJOA (OR 0.32, p = 0.007) and NDI (OR 0.42, p = 0.031) scores. The results were consistent in sensitivity analyses. The doubly robust model identified a BMI range of 29.1\u201336.7 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , where anterior approaches significantly increased the probability of optimal outcomes (risk difference &gt; 8.1%; lower confidence interval &gt; 0). Anterior approaches also demonstrated greater probability of achieving optimal outcomes at higher BMIs, though without statistical significance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\n                      For BMI &lt; 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , both approaches improved disability and quality of life, with anterior surgery offering added relief of arm pain. For BMI \u2265 30 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , anterior surgery provided superior functional and disability outcomes. Most importantly, anterior surgery became significantly more advantageous beginning at BMI 29.1 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      . However, approach selection remains multifactorial, as anterior and posterior cohorts differed in mean age (anterior 58.7 vs posterior 64.5 years) and mean operated levels (anterior 1.9 vs posterior 4.2 levels). While anterior approaches may be most commonly employed for younger patients or for one- and two-level pathology, posterior approaches remain an important option for multilevel cervical stenosis or in the elderly to avoid dysphagia. Thus, this study highlights BMI as just one of many key factors in approach selection for CSM, but should not replace individualized clinical decision-making.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.12.focus25940","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T11:31:13Z","timestamp":1777635073000},"page":"E7","source":"Crossref","is-referenced-by-count":0,"title":["Should BMI influence anterior versus posterior approach surgery in patients with CSM? A 5-year Spine CORe\u2122 analysis of QOD data"],"prefix":"10.3171","volume":"60","author":[{"given":"Farhan A.","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Chabot","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erica F.","family":"Bisson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah, Salt Lake City, Utah;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Chicago, Illinois;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony L.","family":"Asher","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Kim","sequence":"additional","affiliation":[{"name":"Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A.","family":"Potts","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J.","family":"Alentado","sequence":"additional","affiliation":[{"name":"Goodman Campbell Brain and Spine, Indianapolis, Indiana;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin T.","family":"Foley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Miami, Florida;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Virk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Weill Cornell Medical Center, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oren N.","family":"Gottfried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Maxim Spine, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Meyer","sequence":"additional","affiliation":[{"name":"Maxim Spine, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tennessee, Semmes Murphey Neurologic and Spine Institute, Memphis, Tennessee;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheerag D.","family":"Upadhyaya","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Po","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Yee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"Am Fam Physician","first-page":"1064","article-title":"Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons","volume":"62","author":"Young WF","year":"2000","unstructured":"Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000;62(5):1064\u20131073. doi:10.1212\/wnl.42.8.1614"},{"issue":"11","key":"b2","series-title":"JAMA Surg","first-page":"1024","article-title":"Early vs late surgical decompression for central cord syndrome","volume":"157","author":"Badhiwala JH","year":"2022","unstructured":"Badhiwala JH, Wilson JR, Harrop JS,  Early vs late surgical decompression for central cord syndrome. JAMA Surg. 2022;157(11):1024\u20131032. doi:10.1001\/jamasurg.2022.4454"},{"issue":"3 Suppl","key":"b3","series-title":"Global Spine J","first-page":"195s","article-title":"A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (\u226424 hours versus >24 hours) of decompressive surgery","volume":"7","author":"Fehlings MG","year":"2017","unstructured":"Fehlings MG, Tetreault LA, Wilson JR,  A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (\u226424 hours versus >24 hours) of decompressive surgery. Global Spine J. 2017;7(3 Suppl):195s\u2013202s.  doi:10.1177\/2192568217706367"},{"issue":"4","key":"b4","series-title":"Neurosurgery","first-page":"334","article-title":"Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale","volume":"75","author":"Ghogawala Z","year":"2014","unstructured":"Ghogawala Z, Benzel EC, Heary RF,  Cervical spondylotic myelopathy surgical trial: randomized, controlled trial design and rationale. Neurosurgery. 2014;75(4):334\u2013346. doi:10.1227\/NEU.0000000000000479"},{"issue":"5","key":"b5","series-title":"J Neurosurg Spine","first-page":"604","article-title":"Do class III obese patients achieve similar outcomes and satisfaction to nonobese patients following surgery for cervical myelopathy? 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J Neurosurg Spine. 2024;40(4):428\u2013438. doi:10.3171\/2023.11.SPINE23127"},{"issue":"1","key":"b7","series-title":"Neurosurg Focus","first-page":"E4","article-title":"Defining cervical spondylotic myelopathy surgical endotypes using comorbidity clustering: a Quality Outcomes Database cervical spondylotic myelopathy study","volume":"59","author":"Yang E","year":"2025","unstructured":"Yang E, Howell H, Mummaneni PV,  Defining cervical spondylotic myelopathy surgical endotypes using comorbidity clustering: a Quality Outcomes Database cervical spondylotic myelopathy study. Neurosurg Focus. 2025;59(1):E4. doi:10.3171\/2025.4.FOCUS25207"},{"issue":"4","key":"b8","series-title":"J Neurosurg Spine","first-page":"453","article-title":"What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study","volume":"40","author":"Chan AK","year":"2024","unstructured":"Chan AK, Park C, Shaffrey CI,  What predicts the best 24-month outcomes following surgery for cervical spondylotic myelopathy? A QOD prospective registry study. J Neurosurg Spine. 2024;40(4):453\u2013464. doi:10.3171\/2023.11.SPINE23222"},{"key":"b9","series-title":"World Neurosurg","first-page":"e436","article-title":"Differences in patient-reported outcomes between anterior and posterior approaches for treatment of cervical spondylotic myelopathy: a Quality Outcomes Database analysis","volume":"160","author":"Wilkerson CG","year":"2022","unstructured":"Wilkerson CG, Sherrod BA, Alvi MA,  Differences in patient-reported outcomes between anterior and posterior approaches for treatment of cervical spondylotic myelopathy: a Quality Outcomes Database analysis. 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