Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

BMC Surgery

Kunihiko Takahashi¹  Kanji Mori²  Akira Nakamura²  Asato Maekawa³  Kenji Endo³  Toshitaka Yoshii⁴  Takashi Hirai⁴  Atsushi Okawa⁴  Hiroyuki Inose⁵  Atsushi Kimura⁶  Katsushi Takeshita⁶  Hirokazu Inoue⁶  Takeo Furuya⁷  Shoji Seki⁸  Shunji Matsunaga⁹  Shiro Imagama^1,10  Shunsuke Kanbara^1,10 

[1] Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan;Department of Orthopaedic Surgery, Shiga University of Medical Science, Otsu, Japan;Department of Orthopaedic Surgery, Tokyo Medical University, Tokyo, Japan;Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;Department of Orthopaedic and Trauma Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, 113-8519, Tokyo, Japan;Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan;Department of Orthopaedics, Jichi Medical University, Shimotsuke, Japan;Department of Orthopedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan;Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan;Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima, Japan;Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan;

关键词: Spinal Stenosis;    Spondylosis;    Ossification of Posterior Longitudinal Ligament;    Neck Pain;    Spinal Fusion;   

DOI  :  10.1186/s12893-021-01147-w

来源: Springer

【 摘 要 】

BackgroundAnterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. We aimed to identify clinical and radiological predictors associated with neurological recovery after ADF.MethodsThis post-hoc analysis from a prospective multicenter study included patients who were scheduled for ADF for DCM. The patients who received other surgeries (laminoplasty, posterior decompression and fusion) were excluded. The associations between baseline clinical and radiographic variables (age, sex, body mass index, etiology, cervical lordosis, range of motion, C7 slope, C2-7 sagittal vertical axis [SVA], thoracic kyphosis [TK], lumbar lordosis, sacral slope, SVA, pelvic tilt, T1 pelvic angle [TPA], the Japanese Orthopedic Association score for the assessment of cervical myelopathy [C-JOA], European Quality of Life Five Dimensions Scale [EQ-5D], Neck Disability Index [NDI], Physical Component Summary of the SF-36 [PCS], and Mental Component Summary of the SF-36) and the recovery rates as the outcome variables were investigated in the univariate regression analysis. Then, the independent predictors for increased recovery rates were evaluated using a stepwise multiple regression analysis.ResultsIn total, 37 patients completed the 1 year follow-up. The recovery rate was significantly correlated with SVA (p = 0.001) and TPA (p = 0.03). Univariate regression analyses showed that age (Regression coefficient = − 0.92, p = 0.049), SVA (Regression coefficient  = − 0.57, p = 0.004) and PCS (Regression coefficient = 0.80, p = 0.03) score were significantly associated with recovery rate. Then, a stepwise multiple regression analysis identified the independent predictors of recovery rate after ADF as TK (p = 0.01), PCS (p = 0.03), and SVA (p = 0.03). According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) − 0.45 × (SVA) + 0.85 × (PCS) (p = 0.002, R2 = 0.44).ConclusionPatients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, patients with DCM and these predictors who undergo ADF should be warned about poor recovery and be required to provide adequate informed consent.

【 授权许可】

CC BY