Impact of surgeon experience on surgical outcomes after posterior decompression for degenerative cervical myelopathy: A prospective multicenter study.

STUDY

DESIGN

Prospective multicenter cohort study.

OBJECTIVES

To investigate how surgeon experience influences surgical, radiologic outcomes, and patient-reported outcomes (PROMs) after posterior decompression in patients with degenerative cervical myelopathy (DCM).

SETTING

The multiple institutions in Japan.

METHODS

We prospectively enrolled 775 patients with DCM who underwent posterior decompression at 10 academic institutions in Japan. Surgeries were performed by either board-certified spine (BCS) surgeons or non-BCS (NBCS) surgeons under direct BCS supervision. Outcomes included surgical parameters, radiographic findings, physician-reported measures, and PROMs, such as the JOA score, Visual Analog Scale (VAS) for pain, JOACMEQ, and SF-36 scores, assessed preoperatively and at 2 years follow-up.

RESULTS

Baseline demographics were comparable between groups, except for a higher prevalence of diabetes in the BCS group (p = 0.044). The NBCS group had longer surgical duration (91.1 ± 33.1 minutes vs. 109.4 ± 51.8 minutes, p < 0.001) and greater blood loss (33.7 ± 56.3 mL vs. 45.9 ± 79.4 mL, p = 0.018), despite fewer operated laminae (4.1 ± 1.1 vs. 3.8 ± 1.2, p < 0.001). Perioperative complication rates and radiographic outcomes at 2 years were similar between groups. Both groups showed significant improvements in JOA scores, VAS, all JOACMEQ domains, and most SF-36 subscales, with no significant differences between groups.

CONCLUSION

Posterior decompression for DCM can achieve favorable results when performed by NBCS surgeons under BCS supervision, with outcomes equivalent to those of BCS surgeons. These findings support the safety and educational value of supervised training in spine surgery.