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Risk Factors for Rapidly Progressive Neurological Deterioration in Cervical Spondylotic Myelopathy

Takasawa, Eiji, MD, PhD∗,†; Sorimachi, Yasunori, MD, PhD∗,†; Iizuka, Yoichi, MD, PhD; Tsunoda, Daisuke, MD, PhD; Mieda, Tokue, MD, PhD; Iizuka, Haku, MD, PhD; Chikuda, Hirotaka, MD, PhD

doi: 10.1097/BRS.0000000000002969
CERVICAL SPINE
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Study Design. A retrospective single-center study.

Objective. This study sought to clarify the risk factors and to evaluate the surgical outcome in patients with rapidly progressive cervical spondylotic myelopathy (rp-CSM).

Summary of Background Data. CSM is a degenerative spine disease presenting a slow development of myelopathy. Some patients, however, show rapidly progressive neurological deterioration (especially gait disturbances) without any trauma. At present, there is little information about this condition.

Methods. We studied 71 consecutive CSM patients (52 men, 19 women) with a mean age of 67.1 years, and the follow-up period was 1 year. Patients were divided into two groups: rp-CSM and chronic-CSM (c-CSM) groups. The Japanese Orthopaedic Association score and various clinical differences, including age, sex, comorbidity, the waiting period from symptomatic onset to surgery, cervical range of motion, and intramedullary MR T2-hyperintensity were analyzed, and independent risk factors were determined using a logistic regression analysis.

Results. Eighteen of 71 patients (25.4%) were diagnosed with rp-CSM. There were no significant differences between the two groups with regard to age, sex, or cervical range of motion. In the rp-CSM group, the preoperative upper/lower extremities and bladder functions were worse, and the waiting period for surgery was shorter (rp-CSM 1.2 mo, c-CSM 25.7 mo). Patients with rp-CSM had a history of cardiovascular event (CVE) (rp-CSM 44.4%, c-CSM 15.1%) and presented with MR T2-hyperintensity (rp-CSM 94.4%, c-CSM 58.5%), especially at the C4/5 disc level. Independent risk factors were a history of CVE (odds ratio = 4.7) and MR T2-hyperintensity (odds ratio = 12.5). The rp-CSM group showed a better neurological recovery after decompression surgery (the Japanese Orthopaedic Association recovery rate: rp-CSM 64.5%, c-CSM 40.7%).

Conclusion. A history of CVE and MR T2-hyperintensity were risk factors for rp-CSM. Despite rapid neurological deterioration, rp-CSM patients showed a good neurological recovery after surgery, and thus indicating that rp-CSM is a reversible condition.

Level of Evidence: 4

A history of cardiovascular event and intramedullary MR T2-hyperintensity were independent risk factors for rapidly progressive cervical spondylotic myelopathy (rp-CSM). Despite rapid neurological deterioration, rp-CSM patients showed a good neurological recovery after decompression surgery, and thus indicating that rp-CSM is a reversible condition.

Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan

Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan.

Address correspondence and reprint requests to Eiji Takasawa, MD, PhD, Department of Orthopaedic Surgery, Japanese Red Cross Maebashi Hospital, 3-21-36, Asahi-cho, Maebashi, Gunma 371-0014, Japan; E-mail: eijitakasawa@yahoo.co.jp

Received 31 May, 2018

Revised 31 October, 2018

Accepted 08 November, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

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