{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T07:38:32Z","timestamp":1781941112011,"version":"3.54.5"},"reference-count":110,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Coexisting medical conditions are increasingly prevalent in surgical populations. The impact of multiple comorbidities on patient-reported outcomes (PROs) and endotypes of frequently co-occurring conditions for cervical spondylotic myelopathy (CSM) remain unclear. This study explores whether CSM patients with multimorbidity have worse baseline and postoperative PROs and less functional improvement after surgery compared to those with few or no comorbidities. The authors also investigated whether distinct comorbidity endotypes exist among CSM surgical patients and whether they influence postoperative outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>The prospective Quality Outcomes Database (QOD) was used to assess patients undergoing surgery for CSM. Multimorbidity was defined as \u2265 2 chronic conditions, including diabetes, coronary artery disease, peripheral vascular disease, arthritis, chronic renal disease, chronic obstructive pulmonary disease, Parkinson\u2019s disease, multiple sclerosis, depression, and anxiety. Baseline characteristics and 24-month PROs were assessed across multiple-comorbidity status, including modified Japanese Orthopaedic Association (mJOA), Neck Disability Index (NDI), visual analog scale for neck and arm pain, EQ-5D, and patient satisfaction scores. Clusters were identified from the full cohort using k-medoids, revealing subgroups with similar comorbidity endotypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      The final cohort included 1141 CSM patients (83.1% reaching 24-month follow-up), with 761 (66.7%) having 0 or 1 comorbidity and 380 (33.3%) \u2265 2 comorbidities. The multimorbidity cohort was older (mean age 62.6 \u00b1 11.2 vs 59.5 \u00b1 12.0 years, p &lt; 0.001), more likely to be female (52.9% vs 44.7%, p = 0.011), and had a higher BMI (mean 31.1 \u00b1 6.7 vs 29.7 \u00b1 6.2 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , p &lt; 0.001). Multimorbidity patients exhibited worse mJOA, NDI, and EQ-5D scores at baseline and 24 months (p &lt; 0.05). On multivariable analysis, the total number of comorbidities was not significantly associated with any PRO measures. Four comorbidity clusters were identified: low burden, arthritis, diabetes, and high burden. On one-way ANOVA, the baseline mJOA score was significantly different across clusters (p = 0.003). At 24 months, the mJOA score was significantly lower in the diabetes and high-burden endotypes. Twenty-four-month score change and minimal clinically important difference (MCID) achievement of all PROs remained similar across clusters (p &gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>While patients with multimorbidity have worse baseline and postoperative PROs, they achieve similar functional and pain-related improvements following CSM surgery. Similarly, the comorbidity endotypes identified in this QOD cohort suggest that certain patterns of coexisting chronic conditions, such as overlapping diabetes and arthritis, are associated with different levels of disability but may not diminish the effectiveness of surgical intervention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.focus25207","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T02:14:50Z","timestamp":1751336090000},"page":"E4","source":"Crossref","is-referenced-by-count":1,"title":["Defining cervical spondylotic myelopathy surgical endotypes using comorbidity clustering: a Quality Outcomes Database cervical spondylotic myelopathy study"],"prefix":"10.3171","volume":"59","author":[{"given":"Eunice","family":"Yang","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":"Harrison","family":"Howell","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":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California, San Francisco, California;"}],"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":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;"}],"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":"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":"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":"Domagoj","family":"Coric","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":"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":"John J.","family":"Knightly","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, Morristown, New Jersey;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Meyer","sequence":"additional","affiliation":[{"name":"Atlantic Neurosurgical Specialists, 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 at 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":"Juan S.","family":"Uribe","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Tumial\u00e1n","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Barrow Neurological Institute, Phoenix, Arizona; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regis W.","family":"Haid","sequence":"additional","affiliation":[{"name":"Atlanta Brain and Spine Care, Atlanta, Georgia"}],"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":"1","key":"b1","series-title":"Nat Rev Dis Primers","first-page":"48","article-title":"Multimorbidity","volume":"8","author":"Skou ST","year":"2022","unstructured":"Skou ST, Mair FS, Fortin M,  Multimorbidity. 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Incidence and risk factors for postoperative pulmonary complications in elective intracranial surgery. J Neurosurg. 2008;109(2):222\u2013227."},{"issue":"3","key":"b18","series-title":"J Neurosurg","first-page":"580","article-title":"The impact of patient age and comorbidities on the occurrence of \"never events\" in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample: clinical article","volume":"121","author":"Wen T","year":"2014","unstructured":"Wen T, He S, Attenello F,  The impact of patient age and comorbidities on the occurrence of \"never events\" in cerebrovascular surgery: an analysis of the Nationwide Inpatient Sample: clinical article. 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Neurospine. 2019;16(3):403\u2013407."},{"key":"b21","series-title":"World Neurosurg","first-page":"699","article-title":"Comparing quality of life in cervical spondylotic myelopathy with other chronic debilitating diseases using the Short Form Survey 36-Health Survey","volume":"106","author":"Oh T","year":"2017","unstructured":"Oh T, Lafage R, Lafage V,  Comparing quality of life in cervical spondylotic myelopathy with other chronic debilitating diseases using the Short Form Survey 36-Health Survey. World Neurosurg. 2017;106:699\u2013706."},{"issue":"17","key":"b22","series-title":"Spine (Phila Pa 1976)","first-page":"1322","article-title":"A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients","volume":"40","author":"Fehlings MG","year":"2015","unstructured":"Fehlings MG, Ibrahim A, Tetreault L,  A global perspective on the outcomes of surgical decompression in patients with cervical spondylotic myelopathy: results from the prospective multicenter AOSpine international study on 479 patients. Spine (Phila Pa 1976). 2015;40(17):1322\u20131328."},{"issue":"9","key":"b23","series-title":"Spine J","first-page":"S79","article-title":"159. 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J Neurosurg Spine. 2024;40(4):453\u2013464."},{"issue":"5","key":"b25","series-title":"J Neurosurg Spine","first-page":"758","article-title":"Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study","volume":"37","author":"Berlin C","year":"2022","unstructured":"Berlin C, Marino AC, Mummaneni PV,  Determining the time frame of maximum clinical improvement in surgical decompression for cervical spondylotic myelopathy when stratified by preoperative myelopathy severity: a cervical Quality Outcomes Database study. J Neurosurg Spine. 2022;37(5):758\u2013766."},{"issue":"3","key":"b26","series-title":"J Neurosurg Spine","first-page":"357","article-title":"Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study","volume":"38","author":"Sherrod BA","year":"2023","unstructured":"Sherrod BA, Michalopoulos GD, Mulvaney G,  Development of new postoperative neck pain at 12 and 24 months after surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine. 2023;38(3):357\u2013365."},{"issue":"6","key":"b27","series-title":"Neurosurg Focus","first-page":"E5","article-title":"Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? A QOD study","volume":"54","author":"Park C","year":"2023","unstructured":"Park C, Mummaneni PV, Gottfried ON,  Which supervised machine learning algorithm can best predict achievement of minimum clinically important difference in neck pain after surgery in patients with cervical myelopathy? A QOD study. Neurosurg Focus. 2023;54(6):E5."},{"issue":"22","key":"b28","series-title":"Spine (Phila Pa 1976)","first-page":"1541","article-title":"Development and validation of cervical prediction models for patient-reported outcomes at 1 year after cervical spine surgery for radiculopathy and myelopathy","volume":"45","author":"Archer KR","year":"2020","unstructured":"Archer KR, Bydon M, Khan I,  Development and validation of cervical prediction models for patient-reported outcomes at 1 year after cervical spine surgery for radiculopathy and myelopathy. Spine (Phila Pa 1976). 2020;45(22):1541\u20131552."},{"issue":"1","key":"b29","series-title":"J Neurosurg Spine","first-page":"25","article-title":"Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database","volume":"35","author":"Mummaneni PV","year":"2021","unstructured":"Mummaneni PV, Bydon M, Knightly JJ,  Identifying patients at risk for nonroutine discharge after surgery for cervical myelopathy: an analysis from the Quality Outcomes Database. J Neurosurg Spine. 2021;35(1):25\u201333."},{"issue":"4","key":"b30","series-title":"J Neurosurg Spine","first-page":"568","article-title":"Association of \u2265 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database","volume":"36","author":"Asuzu DT","year":"2022","unstructured":"Asuzu DT, Yun JJ, Alvi MA,  Association of \u2265 12 months of delayed surgical treatment for cervical myelopathy with worsened postoperative outcomes: a multicenter analysis of the Quality Outcomes Database. J Neurosurg Spine. 2022;36(4):568\u2013574."},{"issue":"1","key":"b31","series-title":"J Neurosurg Spine","first-page":"31","article-title":"High-impact chronic pain transition in surgical recipients with cervical spondylotic myelopathy","volume":"37","author":"Cook CE","year":"2022","unstructured":"Cook CE, George SZ, Asher AL,  High-impact chronic pain transition in surgical recipients with cervical spondylotic myelopathy. J Neurosurg Spine. 2022;37(1):31\u201340."},{"issue":"3","key":"b32","series-title":"J Neurosurg Spine","first-page":"339","article-title":"Differences in postoperative quality of life in young, early elderly, and late elderly patients undergoing surgical treatment for degenerative cervical myelopathy","volume":"37","author":"Croci DM","year":"2022","unstructured":"Croci DM, Sherrod B, Alvi MA,  Differences in postoperative quality of life in young, early elderly, and late elderly patients undergoing surgical treatment for degenerative cervical myelopathy. J Neurosurg Spine. 2022;37(3):339\u2013349."},{"issue":"1","key":"b33","series-title":"J Neurosurg Spine","first-page":"41","article-title":"Social risk factors predicting outcomes of cervical myelopathy surgery","volume":"37","author":"Rethorn ZD","year":"2022","unstructured":"Rethorn ZD, Cook CE, Park C,  Social risk factors predicting outcomes of cervical myelopathy surgery. J Neurosurg Spine. 2022;37(1):41\u201348."},{"key":"b34","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. World Neurosurg. 2022;160:e436\u2013e441."},{"issue":"6","key":"b35","series-title":"Neurosurgery","first-page":"952","article-title":"Correlation of the modified Japanese Orthopedic Association with functional and quality-of-life outcomes after surgery for degenerative cervical myelopathy: a quality outcomes database study","volume":"91","author":"Yee TJ","year":"2022","unstructured":"Yee TJ, Upadhyaya C, Coric D,  Correlation of the modified Japanese Orthopedic Association with functional and quality-of-life outcomes after surgery for degenerative cervical myelopathy: a quality outcomes database study. Neurosurgery. 2022;91(6):952\u2013960."},{"issue":"3","key":"b36","series-title":"Neurosurg Focus","first-page":"E2","article-title":"Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort","volume":"55","author":"Ambati VS","year":"2023","unstructured":"Ambati VS, Macki M, Chan AK,  Three-level ACDF versus 3-level laminectomy and fusion: are there differences in outcomes? An analysis of the Quality Outcomes Database cervical spondylotic myelopathy cohort. Neurosurg Focus. 2023;55(3):E2."},{"issue":"6","key":"b37","series-title":"J Neurosurg","first-page":"1757","article-title":"Research using the Quality Outcomes Database: accomplishments and future steps toward higher-quality real-world evidence","volume":"139","author":"Asher AL","year":"2023","unstructured":"Asher AL, Haid RW, Stroink AR,  Research using the Quality Outcomes Database: accomplishments and future steps toward higher-quality real-world evidence. J Neurosurg. 2023;139(6):1757\u20131775."},{"issue":"5","key":"b38","series-title":"J Neurosurg Spine","first-page":"530","article-title":"Characteristics of patients who return to work after undergoing surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study","volume":"38","author":"Bergin SM","year":"2023","unstructured":"Bergin SM, Michalopoulos GD, Shaffrey CI,  Characteristics of patients who return to work after undergoing surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study. J Neurosurg Spine. 2023;38(5):530\u2013539."},{"issue":"3","key":"b39","series-title":"Clin Spine Surg","first-page":"112","article-title":"Sleep disturbances in cervical spondylotic myelopathy","volume":"36","author":"Bisson EF","year":"2023","unstructured":"Bisson EF, Mummaneni PV, Michalopoulos GD,  Sleep disturbances in cervical spondylotic myelopathy. 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