Degenerative Cervical Myelopathy (DCM)
Degenerative cervical myelopathy (DCM) is the leading cause of spinal cord impairments in adults worldwide. Recent evidence indicates that surgical intervention for DCM is associated with improved function and quality of life, regardless of disease severity. Albeit effective, surgery for DCM remains costly. Moreover, wait times for spine surgery in Ontario remain lengthy and this is likely to continue as the population ages. Health policymakers require an assessment of quality and value of surgery to develop an informed decision and optimize health resource allocation.
Cost-Effectiveness of Surgery for DCM – Dr. Christopher Witiw and Dr. Michael Fehlings
Through PSI’s Resident Research funding stream, Dr. Christopher Witiw, along with his supervisor Dr. Michael G. Fehlings of Toronto Western Hospital, conducted a study to determine the cost effectiveness of surgical intervention for DCM. The investigators found that surgery provided a 
significant improvement in quality of life and by using health economic calculations; they determined that 97.9% of interventions are very cost-effective relative to non-operative management. This finding suggests that resource allocation toward improving access to spinal surgery for those with debilitating condition is an effective allocation of resources. These findings will serve to provide surgeons and policymakers with the evidence needed to guide decision-making and optimize healthcare expenditures.
“This resident research grant, which I received from the PSI Foundation was a tremendous resource. The funding was instrumental in providing the means to combine my research training in health economics with my clinical focus on spine surgery to complete this important evaluation of the value of surgery for Degenerative Cervical Myelopathy.”
Impact of the Findings
Dr. Witiw was awarded the highly prestigious North American Spine Society Outstanding Paper Award for the manuscript based upon the findings of the study, which was published in The Spine Journal. Moreover, the data has been presented at numerous international spine surgical conferences and have been honoured with prestigious awards from a number of spinal surgical societies. Furthermore, the findings have been recently incorporated into international surgical guidelines regarding the management of Degenerative Cervical Myelopathy. Despite the success in knowledge translation to the academic spine surgery community thus far, Dr. Witiw believes more is needed to disseminate these findings to those responsible for healthcare resource allocation.
“Much of the care provided by spine surgeons is costly, but at the same time makes a tremendously positive impact on a patient’s quality of life. As healthcare resources become increasingly strained, more research pertaining to cost-effectiveness is needed to empower physicians to work with health policy makers to provide optimal care.”
Future Directions
Dr. Witiw has recently completed his neurosurgical residency training at the University of Toronto and is currently spending 1 year enrolled in a Spinal Neurosurgery Fellowship at Rush University Medical Center in Chicago. Here he is focusing on learning minimally invasive techniques for spine surgery, with the goals of lessening post-operative pain, reducing length of hospital stay and complications and optimizing outcomes. Following this, he plans to return to Toronto to a position as a spine surgeon at the University of Toronto and St. Michael’s Hospital where he hopes to continue his work on studying and improving the value of spine surgery for patients in Ontario.