Interestingly they did find differences. For example, they found that patients with private health insurance were more likely to have an anterior (operation from the front of the neck) than a posterior (operation from the back of the neck) procedure.
At present there is no definite evidence that outcomes are effected by the direction from which surgery is performed. In fact a large study published in 2013 found they were equally effective.
The significance of these findings therefore are unclear. But regardless, the identification that factors such as insurance status might influence a patient's care, are disappointing.
1. McClelland et al Impact of Race and Insurance Status on Surgical Approach for Cervical Spondylotic Myelopathy in the United States: a Population-Based Analysis. Spine (Phil) May 2016
Following on from our blog post showing damage above the level of spinal cord compression, this is further evidence that CSM impacts on the entire central nervous system.
There remain a lot of unanswered questions, including what the exact role of NAA is and its significance in CSM.
However, this is an exciting piece of work, showing that the implications of the disease are not just isolated to the level of compression, as has been the focus of research for many years.
Regardless this is promising as it provides further evidence for additional therapies that in combination with surgery may offer a better chance of a full recovery. Given this medication is already in use in clinical medicine, experimentation in humans is not necessarily that far. We will have to watch this space!
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