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Prevalence and Predictive Factors of Concurrent Cervical Spinal Cord Compression in Adult Spinal Deformity

Shimizu, Takayoshi MD, PhD∗,†; Lehman, Ronald A. Jr MD; Pongmanee, Suthipas MD; Alex Sielatycki, J. MD; Leung, Eric BA; Riew, K. Daniel MD; Lenke, Lawrence G. MD

doi: 10.1097/BRS.0000000000003007
CERVICAL SPINE
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Study Design. Retrospective cross-sectional cohort.

Objective. To investigate the prevalence and predictive factors of concurrent cervical spinal cord compression (CSCC) in patients with adult spinal deformity (ASD).

Summary of Background Data. In patients with ASD undergoing major thoracolumbar realignment surgery, concurrent CSCC potentially increases the risk of progression of myelopathy or cervical cord injury due to various perioperative factors including poor intraoperative neck positioning and hypotension. However, the prevalence of CSCC in ASD patients has not been previously studied.

Methods. This study included ASD patients who were indicated for major thoracolumbar corrective surgery (>5 levels). The presence of CSCC was determined using the modified Cord Compression Index (Grades 0–3) based on the cervical magnetic resonance imaging (MRI). Significant CSCC was defined as Grade>2, and the distribution of compression level as well as the number of Grade>2 segments were investigated in each patient. A multivariate regression analysis was performed to identify the predictors of CSCC with variables being the patients’ characteristics including radiographic sagittal alignment parameters.

Results. Of 121 patients with ASD, 41 patients (33.8%) demonstrated significant CSCC on MRI. Intramedullary T2 hyper-intensity (myelomalacia) was present in eight patients (6.6%). Thirty-five of 41 patients were asymptomatic or with myelopathy that is difficult to detect. Significant CSCC was most commonly observed at C4/5 level. Four patients (3.3%) underwent cervical decompression and fusion prior to thoracolumbar reconstruction. Multivariate regression analysis revealed old age, increased body mass index (BMI), and PI-LL mismatch independently predicted the CSCC grade.

Conclusion. The prevalence of concurrent significant cervical cord compression in patients with ASD is relatively high at 33.8%. Preoperative evaluation of cervical MRI and examinations for signs/symptoms of myelopathy are essential for patients with (1) older age, (2) increased BMI, and (3) high PI-LL mismatch to avoid progressive myelopathy or cord injury during ASD surgery.

Level of Evidence: 4

The prevalence of concurrent cervical spinal cord compression (CSCC) in patients with adult spinal deformity is relatively high at 33.8%. Old age, increased BMI, and high PI-LL mismatch independently predicted the CSCC grade. Preoperative evaluation of cervical magnetic resonance imaging in addition to examinations for symptoms of myelopathy is essential.

Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY

Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Address correspondence and reprint requests to Ronald A. Lehman Jr, MD, Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York 10034, NY; E-mail: rl2781@cumc.columbia.edu

Received 10 September, 2018

Revised 13 December, 2018

Accepted 30 January, 2019

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

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, grants, royalties, payment for lecture, expert testimony, travel/accommodations/meeting expenses.

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