268. Frailty is a better predictor than age of mortality and perioperative complications after surgery for Degenerative Cervical Myelopathy: An analysis of 41,369 patients from the NSQIP database 2010-2018

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

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Perioperative Complications of Laminoplasty in Degenerative Cervical Myelopathy -A Comparative Study Between Ossification of Posterior Longitudinal Ligament and Cervical Spondylotic Myelopathy Using a Nationwide Inpatient Database

Global Spine Journal ◽

10.1177/21925682211063867 ◽

2021 ◽

pp. 219256822110638

Author(s):

Shingo Morishita ◽

Toshitaka Yoshii ◽

Hiroyuki Inose ◽

Takashi Hirai ◽

Masato Yuasa ◽

...

Keyword(s):

Cervical Myelopathy ◽

Cervical Spondylotic Myelopathy ◽

Perioperative Complications ◽

Posterior Longitudinal Ligament ◽

Medical Costs ◽

Complication Rates ◽

Systemic Complications ◽

Hospitalization Costs ◽

Degenerative Cervical Myelopathy ◽

Inpatient Database

Study Design Retrospective cohort study. Objectives Laminoplasty (LAMP) is one of the effective methods to successfully achieve surgical decompression in patients with degenerative cervical myelopathy (DCM). However, little evidence exists regarding the perioperative complications in LAMP for patients with ossification of the longitudinal ligament (OPLL) compared with cervical spondylotic myelopathy (CSM). We aimed to investigate the perioperative complication rates and medical costs of DCM, including OPLL and CSM patients who underwent LAMP using a large national inpatient database. Methods This study identified patients who underwent LAMP for OPLL and CSM from 2010 to 2016 using the Japanese Diagnosis Procedure Combination database. We compared the incidence of perioperative complications (systemic and local), reoperation rates, medical costs during hospitalization, and mortality were between the OPLL and CSM groups after propensity score matching. Results This study included 22,714 patients (OPLL: 7485 patients, CSM: 15,229 patients). Consequently, 7169 pairs were matched. More perioperative systemic complications were detected in the OPLL group (one complication: 9.1% vs 7.7%; P = .002), especially for pneumonia (.5% vs .2%; P = .001) and dysphagia (.5% vs .2%; P = .004). The local complication rate was also higher in the OPLL group (paralysis: 1.1% vs .6%, P = .006; spinal fluid leakage: .4% vs .1%, P = .002). The hospitalization costs were approximately $2300 higher ($19,024 vs $16,770; P < .001) in the OPLL group. Conclusions More perioperative complications and higher medical costs were noted in patients with OPLL than in patients with CSM who underwent LAMP.

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A Systematic Review of Definitions for Dysphagia and Dysphonia in Patients Treated Surgically for Degenerative Cervical Myelopathy

Global Spine Journal ◽

10.1177/21925682211035714 ◽

2021 ◽

pp. 219256822110357

Author(s):

Lindsay Tetreault ◽

Stefan F. Lange ◽

Silky Chotai ◽

Mercedes Lupo ◽

Michael T. Kryshtalskyj ◽

...

Keyword(s):

Systematic Review ◽

Study Design ◽

Cervical Myelopathy ◽

Sound Production ◽

Rating Scale ◽

Perioperative Complications ◽

Life Questionnaire ◽

Patient Reported ◽

Degenerative Cervical Myelopathy

Study Design: Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the literature and (2) assess the quality of definitions using a novel 4-point rating system. Methods: An electronic database search was conducted for studies that reported on dysphagia, dysphonia or other related complications of DCM surgery. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A 4-point rating scale was developed to assess the quality of definitions for each complication. Results: Our search yielded 2,673 unique citations, 11 of which met eligibility criteria and were summarized in this review. Defined complications included odynophagia (n = 1), dysphagia (n = 11), dysphonia (n = 2), perioperative swelling complications (n = 2), and soft tissue swelling (n = 3). Rates of dysphagia varied substantially (0.0%-50.0%) depending on whether this complication was patient-reported (4.4%); patient-reported using a modified Swallowing Quality of Life questionnaire (43.1%) or the Bazaz criteria (8.8%-50.0%); or diagnosed using an extensive protocol consisting of clinical assessment, a bedside swallowing test, evaluation by a speech and language pathologist and a modified barium swallowing test/fiberoptic endoscopy (42.9%). The reported incidences of dysphonia also ranged significantly from 0.6% to 38.0%. Conclusion: There is substantial variability in reported rates of dysphagia and dysphonia due to differences in data collection methods, diagnostic strategies, and definitions. Consolidation of nomenclature will improve evaluation of the overall safety of surgery.

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Clinical and Surgical Predictors of Perioperative Complications in Patients with Degenerative Cervical Myelopathy: Results from the Multicenter, Prospective AOSpine International Study on 479 Patients

The Spine Journal ◽

10.1016/j.spinee.2014.08.039 ◽

2014 ◽

Vol 14 (11) ◽

pp. S11-S12

Author(s):

Michael G. Fehlings ◽

Lindsay Tetreault ◽

Nabeel Alshafai ◽

Pierre Cote ◽

Branko Kopjar ◽

...

Keyword(s):

Cervical Myelopathy ◽

Perioperative Complications ◽

International Study ◽

Degenerative Cervical Myelopathy

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Spine Treatment Appraisal Report (STAR): Does Riluzole Improve Outcomes in Patients Undergoing Decompression Surgery for Degenerative Cervical Myelopathy?

Global Spine Journal ◽

10.1177/2192568221997401 ◽

2021 ◽

pp. 219256822199740

Author(s):

Joseph R. Dettori

Keyword(s):

Cervical Myelopathy ◽

Decompressive Surgery ◽

Decompression Surgery ◽

Phase 3 ◽

Double Blind ◽

Safety And Efficacy ◽

Double Blind Placebo ◽

Degenerative Cervical Myelopathy

Fehlings MG, Badhiwala JH, Ahn H, et al. Safety and efficacy of riluzole in patients undergoing decompressive surgery for degenerative cervical myelopathy (CSM-Protect): a multicentre, double-blind, placebo-controlled, randomised, phase 3 trial. Lancet Neurol. 2020.

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Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms

Journal of Clinical Medicine ◽

10.3390/jcm10061214 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1214

Author(s):

Ji Tu ◽

Jose Vargas Castillo ◽

Abhirup Das ◽

Ashish D. Diwan

Keyword(s):

Cervical Myelopathy ◽

Molecular Mechanisms ◽

Current Knowledge ◽

Imaging Techniques ◽

Disease Process ◽

Classification Systems ◽

Molecular Features ◽

Formidable Challenge ◽

Long Term Treatment ◽

Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.

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