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

BACKGROUND: Anterior 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 af...

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Autores principales: Inose, Hiroyuki, Hirai, Takashi, Yoshii, Toshitaka, Kimura, Atsushi, Takeshita, Katsushi, Inoue, Hirokazu, Maekawa, Asato, Endo, Kenji, Furuya, Takeo, Nakamura, Akira, Mori, Kanji, Kanbara, Shunsuke, Imagama, Shiro, Seki, Shoji, Matsunaga, Shunji, Takahashi, Kunihiko, Okawa, Atsushi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980318/
https://www.ncbi.nlm.nih.gov/pubmed/33740929
http://dx.doi.org/10.1186/s12893-021-01147-w
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author Inose, Hiroyuki
Hirai, Takashi
Yoshii, Toshitaka
Kimura, Atsushi
Takeshita, Katsushi
Inoue, Hirokazu
Maekawa, Asato
Endo, Kenji
Furuya, Takeo
Nakamura, Akira
Mori, Kanji
Kanbara, Shunsuke
Imagama, Shiro
Seki, Shoji
Matsunaga, Shunji
Takahashi, Kunihiko
Okawa, Atsushi
author_facet Inose, Hiroyuki
Hirai, Takashi
Yoshii, Toshitaka
Kimura, Atsushi
Takeshita, Katsushi
Inoue, Hirokazu
Maekawa, Asato
Endo, Kenji
Furuya, Takeo
Nakamura, Akira
Mori, Kanji
Kanbara, Shunsuke
Imagama, Shiro
Seki, Shoji
Matsunaga, Shunji
Takahashi, Kunihiko
Okawa, Atsushi
author_sort Inose, Hiroyuki
collection PubMed
description BACKGROUND: Anterior 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. METHODS: This 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. RESULTS: In 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, R(2) = 0.44). CONCLUSION: Patients 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.
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spelling pubmed-79803182021-03-22 Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy Inose, Hiroyuki Hirai, Takashi Yoshii, Toshitaka Kimura, Atsushi Takeshita, Katsushi Inoue, Hirokazu Maekawa, Asato Endo, Kenji Furuya, Takeo Nakamura, Akira Mori, Kanji Kanbara, Shunsuke Imagama, Shiro Seki, Shoji Matsunaga, Shunji Takahashi, Kunihiko Okawa, Atsushi BMC Surg Research Article BACKGROUND: Anterior 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. METHODS: This 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. RESULTS: In 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, R(2) = 0.44). CONCLUSION: Patients 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. BioMed Central 2021-03-19 /pmc/articles/PMC7980318/ /pubmed/33740929 http://dx.doi.org/10.1186/s12893-021-01147-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Inose, Hiroyuki
Hirai, Takashi
Yoshii, Toshitaka
Kimura, Atsushi
Takeshita, Katsushi
Inoue, Hirokazu
Maekawa, Asato
Endo, Kenji
Furuya, Takeo
Nakamura, Akira
Mori, Kanji
Kanbara, Shunsuke
Imagama, Shiro
Seki, Shoji
Matsunaga, Shunji
Takahashi, Kunihiko
Okawa, Atsushi
Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title_full Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title_fullStr Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title_full_unstemmed Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title_short Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
title_sort predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980318/
https://www.ncbi.nlm.nih.gov/pubmed/33740929
http://dx.doi.org/10.1186/s12893-021-01147-w
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