• Omar Khan, Jetan H Badhiwala, Muhammad A Akbar, and Michael G Fehlings.
• Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
• Neurosurgery. 2021 Feb 16; 88 (3): 584-591.

BackgroundSurgical decompression for degenerative cervical myelopathy (DCM) is one of the mainstays of treatment, with generally positive outcomes. However, some patients who undergo surgery for DCM continue to show functional decline.ObjectiveTo use machine learning (ML) algorithms to determine predictors of worsening functional status after surgical intervention for DCM.MethodsThis is a retrospective analysis of prospectively collected data. A total of 757 patients enrolled in 2 prospective AO Spine clinical studies, who underwent surgical decompression for DCM, were analyzed. The modified Japanese Orthopedic Association (mJOA) score, a marker of functional status, was obtained before and 1 yr postsurgery. The primary outcome measure was the dichotomized change in mJOA at 1 yr according to whether it was negative (worse functional status) or non-negative. After applying an 80:20 training-testing split of the dataset, we trained, optimized, and tested multiple ML algorithms to evaluate algorithm performance and determine predictors of worse mJOA at 1 yr.ResultsThe highest-performing ML algorithm was a polynomial support vector machine. This model showed good calibration and discrimination on the testing data, with an area under the receiver operating characteristic curve of 0.834 (accuracy: 74.3%, sensitivity: 88.2%, specificity: 72.4%). Important predictors of functional decline at 1 yr included initial mJOA, male gender, duration of myelopathy, and the presence of comorbidities.ConclusionThe reasons for worse mJOA are frequently multifactorial (eg, adjacent segment degeneration, tandem lumbar stenosis, ongoing neuroinflammatory processes in the cord). This study successfully used ML to predict worse functional status after surgery for DCM and to determine associated predictors.Copyright © 2020 by the Congress of Neurological Surgeons.

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