Eddie de Dios Perez: More patients could be treated without cervical fusion
Degenerative cervical myelopathy (DCM) stands as the leading cause of spinal cord dysfunction in adults. With several surgical treatment methods available, the optimal choice remains uncertain.
Eddie de Dios’ doctoral thesis presents fresh insights into the effectiveness of these methods, potentially leading to fewer cervical fusion surgeries and lower healthcare costs.
EDDIE de DIOS PEREZ
Dissertation Defense: September 15, 2023
Doctoral Thesis: Degenerative cervical myelopathy: Surgical treatment, imaging evaluation, and outcome
Research Area: Radiology and Medical Imaging
Sahlgrenska Academy, The Institute of Clinical Sciences
Degenerative cervical myelopathy (DCM) emerges when degeneration in the cervical spine leads to spinal canal narrowing and impaired spinal cord function.
Classic symptoms include compromised fine motor skills, difficulties in walking, balance disturbances, numbness, and weakness in arms and legs.
”My research is looking into various surgical treatment methods for DCM. It also addresses disease grading scales, radiological assessments, and outcome predictors for patients with this condition,” says Eddie de Dios, who works as a fellow in radiology at Sahlgrenska University Hospital.
Diverse surgical approaches
Several surgical approaches exist for DCM treatment. Decompression via laminectomy enhances spinal canal space to alleviate pressure on the spinal cord. An additional cervical fusion, surgery that joins two or more of the neck vertebrae, can be performed alongside decompression. The aim of fusion surgery is to eliminate motion between the vertebrae and increase stability.
Uncertainty lingers concerning the most effective surgical route. In his doctoral project, Eddie de Dios compares these methods in terms of effectiveness, safety, and cost-efficiency.
”The most significant finding is that our results suggest that in many cases non-fusion treatment can be just as effective as fusion treatment.”
”Important to avoid fusion unless necessary”
The thesis reveals that five years post-operation, decompression via laminectomy alone yielded comparable clinical outcomes to laminectomy paired with fusion. The cost increase per patient treated with fusion was estimated at USD 4,700, without any long-term benefits evident.
”Given the risk for higher healthcare costs and more complications associated with fusion surgeries, it’s important to avoid cervical fusion unless necessary,” Eddie de Dios emphasizes.
Surgery with fewer complications
A third surgical approach for DCM is muscle-preserving selective laminectomy. This variant spares the deep muscles at the back of the cervical spine and increases stability. One segment of the thesis compares this surgical technique with other methods employing cervical fusion.
Clinical improvement two years post-operation was similar across groups receiving different treatments. Additionally, there were no notable differences in reoperation rates. However, muscle-preserving laminectomy demonstrated distinct advantages.
”The method was associated with fewer complications, both general and severe. Moreover, it proved more cost-effective,” Eddie de Dios says.
What do you hope your doctoral project could mean for the future treatment of DCM patients?
”Our aspiration is for the benefits of the muscle-preserving laminectomy technique to gain recognition, and for more comparisons to be made with traditional techniques utilizing cervical fusion. Ultimately, it’s all about using the least invasive and safest surgical method possible, while ensuring that the patient’s outcome and quality of life remain just as good.”
Text: Jakob Lundberg