Thanks, Ian. The next speaker is Dr. Jian Guan, Preliminary Return to Work Data from Multi-Center Prospective Randomized CSM-S Study, Surgical Approach Matters. Great. Thanks, Dr. Bawala. Again, my name is Jian Guan, and today I'm going to be speaking about some of our preliminary return to work data from the CSM study. Here's the disclosures. So, cervical spinal myelopathy, as everyone in this audience knows, is the most common cause of spinal cord injury in the United States, and affects millions of people worldwide every year. Surgical decompression results in significant clinical improvements in patients suffering from CSM, but the optimal approach, primarily anterior versus posterior approaches, is currently unknown. The ability to return to work and timing of return to work are important to patients, obviously, and also to multiple stakeholders, but this is a topic where there's very little data on the CSM population. The CSM-S study is aimed at answering some of these questions. It's a prospective multi-center trial. Patients who are randomized in this trial receive either ventral ACDF or dorsal posterior fusion or laminoplasty procedures. Patients are evaluated by an expert panel to assess their appropriateness before enrollment in the study and before randomization occurs. So, we perform an analysis return to work in a cohort of employed CSM-S study patients. Now, of note, this is just a subset of patients within the entire CSM study itself. 76 patients met criteria, otherwise, in other words, were employed before surgery itself. Of these, 38 were ACDFs, 26 were posterior fusions, and 12 were laminoplasties. Also of note, since this is just an analysis of a cohort of patients, we're not gonna be discussing any of the primary outcomes, including patient-reported outcomes from this main study. So, these are our baseline demographic data points. As you can see here, all of the groups are well-matched in a variety of demographic criteria. The only thing that was different was the number of operated levels. A caveat for this is that this is number of levels that the procedures were performed on. There is gonna be a final independent radiographic review of number of levels of cyanosis on the final data sets, and this could be influenced by things like coding, et cetera, that will be addressed in the final study. In terms of our outcomes, looking at return to work at one year, comparing all three groups, there was a statistically significant difference in the rates of return to work at one year between the anterior cervical discectomy infusion group, the posterior fusion group, and the laminoplasty group. When combining the ventral approaches and the dorsal approaches, in other words, the ACDF group versus both the posterior fusion and laminoplasty groups combined, this difference remains statistically significant. As you can see here, in terms of time to return to work in months, there was no statistical significance when comparing all the groups, but on post-hoc analysis, when looking at the groups individually compared to each other, the laminoplasty group did tend to return to work earlier, about two months versus four months with other groups. Now, one of the things that was brought up is that a lot of this could be due to hard collar use, so we did also look at this, and when examining hard collar use in our patient population, rate of work at return to year was not, sorry, rate of return to work at one year was not significantly different between patients who used a hard collar and those who did not, but patients who did return to work without a hard collar did tend to return to work earlier than those who had a hard collar. We did a multivariable analysis looking at hard collar use and surgical approach, and while surgical approach did remain significantly associated with return to work rates at one year, collar use did not. So in conclusion, the majority of patients undergoing surgical intervention for CSM are able to return to work within one year. Among this cohort, patients undergoing ACDF and laminoplasty were significantly more likely to return to work within one year of surgery compared to those undergoing posterior fusion procedures, and laminoplasty may allow for faster return to work than fusion techniques. Thank you.

CSM-S study

surgical approach

return to work

ACDF

laminoplasty