Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: A prospective study of 81 cases
Published in:Journal of Neurosurgery: Spine
Authors: Julio C. Furlan; Sukhvinder Kalsi-Ryan; Ahilan Kailaya-Vasan; Eric M. Massicotte; Michael G. Fehlings
Year: 2011
Publication details: 14(3):348-355
DOI: 10.3171/2010.10.SPINE091029
Publication type: Prospective clinical study
Topic: cervical myelopathy, spinal cord compression, spine surgery, functional recovery, decompression
Simple summary
This paper supports content on cervical spinal cord compression and the careful assessment of surgical outcomes. It should be framed as evidence about a defined group of patients rather than a guarantee of individual recovery.
Mr Kailaya-Vasan’s involvement
Mr Kailaya-Vasan, consultant neurosurgeon and neurovascular surgeon, is listed as a contributing author on this publication.
Published abstract
The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal dysfunction in the elderly. Operative management is beneficial for most patients with moderate/severe myelopathy. This study examines the potential confounding effects of age, sex, duration of symptoms, and comorbidities on the functional outcomes and postoperative complications in patients who underwent cervical decompressive surgery. We included consecutive patients who underwent surgery from December 2005 to October 2007. Functional outcomes were assessed using the Nurick grading system and the modified Japanese Orthopaedic Association and Berg Balance scales. Comorbidity indices included the Charlson Comorbidity Index and the number of ICD-9 codes. There were 57 men and 24 women with a mean age of 57 years (range 32-88 years). The mean duration of symptoms was 25.2 months (range 1-120 months). There was a significant functional recovery from baseline to 6 months after surgery (p < 0.01). Postoperative complications occurred in 18.5% of cases. Although the occurrence of complications was not significantly associated with sex (p = 0.188), number of ICD-9 codes (p = 0.113), duration of symptoms (p = 0.309), surgical approach (p = 0.248), or number of spine levels treated (p = 0.454), logistic regression analysis showed that patients who developed complications were significantly older than patients who had no complications (p = 0.018). Only older age (p < 0.002) and greater number of ICD-9 codes (p < 0.01) were significantly associated with poorer functional recovery after surgical treatment. However, none of the studied factors were significantly associated with clinically relevant functional recovery after surgical treatment for CSM (p > 0.05). Our results indicate that surgery for CSM is associated with significant functional recovery, which appears to reach a plateau at 6 months after surgery. Age is a potential predictor of complications after decompressive surgery for CSM. Whereas older patients with a greater number of preexisting medical comorbidities had less favorable functional outcomes after surgery for CSM in the multivariate regression analysis, none of the studied factors were associated with clinically relevant functional recovery after surgery in the logistic regression analysis. Therefore, age-matched protocols based on preexisting medical comorbidities may reduce the risk for postoperative complications and improve functional outcomes after surgical treatment for CSM.
Disclaimer
This publication page is provided for general information about Mr Kailaya-Vasan’s academic work. It is not medical advice and should not be used to guide individual diagnosis or treatment decisions. Patients should discuss their individual symptoms, diagnosis and treatment options with a specialist.