Predictors of poor outcome in cervical spondylotic myelopathy patients underwent anterior hybrid approach: focusing on change of local kyphosis

OBJECTIVE The authors recently reported that the presence of chronic kidney disease (CKD) and/or extended abdominal aortic calcification was associated with significantly worse clinical outcomes after posterior lumbar interbody fusion. CKD is one of the highest risk factors for systemic atherosclerosis. Therefore, impaired blood flow due to atherosclerosis could exacerbate degeneration of the cervical spine and neural tissue. However, there has been no report of a study evaluating the deleterious effects of CKD and atherosclerosis on the outcomes after decompression surgery for cervical compression myelopathy. The purpose of this study was thus to examine whether CKD and systemic atherosclerosis affect surgical outcomes after laminoplasty for cervical spondylotic myelopathy (CSM). METHODS The authors analyzed data from 127 consecutive cases involving patients who underwent laminoplasty for CSM and met their inclusion criteria. Stage 3–4 CKD was present as a preoperative comorbidity in 44 cases. Clinical status was assessed using the Japanese Orthopaedic Association (JOA) cervical myelopathy evaluation questionnaire before surgery and 2 years postoperatively. As a marker of systemic atherosclerosis, the presence of aortic arch calcification (AoAC) was assessed on preoperative chest radiographs. RESULTS AoAC was found on preoperative chest radiographs in 40 of 127 patients. Neither CKD nor AoAC had a statistically significant deleterious effect on preoperative JOA score. However, CKD and AoAC were significantly associated with reductions in both the JOA score recovery rate (mean 36.1% in patients with CKD vs 44.7% in those without CKD; 26.0% in patients with AoAC vs 48.9% in those without AoAC) and the change in JOA score at 2 years after surgery (mean 2.3 points in patients with CKD vs 3.1 points in those without CKD; 2.1 points for patients with AoAC vs 3.2 points for those without AoAC). A multivariate regression analysis showed that AoAC was a significant independent predictor of poor outcome with respect to both for the difference between follow-up and preoperative JOA scores and the JOA score recovery rate. CONCLUSIONS CKD and AoAC were associated with increased rates of poor neurological outcomes after laminoplasty for CSM, and AoAC was a significant independent predictive factor for poor outcome.

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Causes of poor outcome in surgery for cervical spondylotic myelopathy: A computed myelography study

Clinical Radiology ◽

10.1016/s0009-9260(88)80114-4 ◽

1988 ◽

Vol 39 (6) ◽

pp. 677

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Poor Outcome ◽

Computed Myelography

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Predictors of poor outcome in cervical spondylotic myelopathy patients underwent anterior hybrid approach: focusing on change of local kyphosis

10.21203/rs.3.rs-23771/v1 ◽

2020 ◽

Author(s):

XingJian Cheng ◽

Lin Jin ◽

Xin Wang ◽

Wen Zhang ◽

Yong Shen

Keyword(s):

Risk Factors ◽

Regression Analysis ◽

Clinical Outcome ◽

Hybrid Approach ◽

Multivariate Logistic Regression Analysis ◽

Local Alignment ◽

Multivariate Logistic Regression ◽

T1 Slope ◽

Local Kyphosis

Abstract Object: This study was a retrospective multivariable analysis for risk factors of poor outcome in patients underwent anterior hybrid approach, and discussed the causes of worsening of postoperative local alignment. Methods: A total of 86 patients with progressive spinal cord compression and local kyphosis underwent an anterior hybrid approach (ACDF + ACCF), between June 2011 and June 2017. We evaluated clinical outcome by the Japanese Orthopaedic Association (JOA) score and recovery rate. Patients were divided into two groups according to worsening and improving of postoperative local alignment. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were applied to the evaluation of risk factors. Mann–Whitney U-test, Independent t-test and Chi-squared test was performed for the comparison of local kyphosis between postoperative and last follow-up. Results: There were twenty patients who had a recovery rate of less than 50%. Advance age, longer duration of symptoms, bigger T1 slope angle and lower change of local kyphosis angle was significantly associated with a poor clinical outcome by multivariate logistic regression analysis. The ROC curve showed that the cutoff values of change of local angle between preoperative and last follow-up was 10.2 angle. The cause of worsening of postoperative local alignment had T1 slope, C2-7 SVA, adjacent segment degeneration (ASD), and implant subsidence. Conclusions: The change of local kyphosis was a predictor of clinical outcome after the hybrid approach. Furthermore, postoperative ASD, implant subsidence, T1 slope and C2-7 Cobb were associated with recurrence of postoperative cervical kyphosis.

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Usefulness of K-line in predicting prognosis of laminoplasty for cervical spondylotic myelopathy

10.21203/rs.3.rs-42579/v1 ◽

2020 ◽

Author(s):

Terumasa Ikeda ◽

Hiroshi Miyamto ◽

Masao Akagi

Keyword(s):

Recovery Rate ◽

Cervical Spondylotic Myelopathy ◽

Posterior Longitudinal Ligament ◽

Cord Compression ◽

Kyphosis Angle ◽

Straight Line ◽

Local Kyphosis ◽

Magnetic Resonance Imaging Mri ◽

Better Than

Abstract Background: K-line is widely recognized as a useful index to evaluate alignment and size of the cervical ossification of the posterior longitudinal ligament (OPLL) in one parameter. The purpose of this study was to investigate that K-line could be a tool to predict the prognosis of LP for cervical spondylotic myelopathy (CSM) as well. Methods: Sixty-eight patients who underwent LP were enrolled. C2-7 angle, local kyphosis angle, and K-line which is the straight line connecting the midpoints of the spinal canal at C2 and C7 was evaluated on T2- weighted sagittal magnetic resonance imaging (MRI). The JOA score and the recovery rate of the JOA score were evaluated at pre-operation and at follow-up. C2/C7 angle, local kyphosis angle, the JOA score, and the recovery rate were compared between K-line (-) and K-line (+) groups. Results: The recovery rate of K-line (+) group (50.6%) was significantly better than that of K-line (-) (19.4%). In K-line (-), the disc type in which the protruded disc was absorbed during the follow-up showed statistically better recovery rate (27.6%) at follow-up compared to other K-line (-) in which anterior cord compression due to the osteophyte or the kyphotic beak was not absorbed (osseous type, 5.0%).Conclusion: The present study has indicated that K-line can be a factor to predict the clinical outcome of LP for CSM. In K-line (-), the disc type showed somewhat better outcomes compared to the osseous type. However, the results were not sufficient.

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