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Article: Neurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients

TitleNeurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients
Authors
Issue Date2-Dec-2022
PublisherLippincott, Williams & Wilkins
Citation
Journal of Bone and Joint Surgery, 2022, v. 105, n. 3, p. 181-190 How to Cite?
Abstract

Background: 

Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration.

Methods: 

A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis.

Results: 

The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019).

Conclusions: 

Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally.


Persistent Identifierhttp://hdl.handle.net/10722/330987
ISSN
2023 Impact Factor: 4.4
2023 SCImago Journal Rankings: 1.705
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorYick, VHT-
dc.contributor.authorZhang, C-
dc.contributor.authorWong, JSH-
dc.contributor.authorNg, SYL-
dc.contributor.authorWong, NST-
dc.contributor.authorWang, H-
dc.contributor.authorKoljonen, PA-
dc.contributor.authorShea, GKH-
dc.date.accessioned2023-09-21T06:51:47Z-
dc.date.available2023-09-21T06:51:47Z-
dc.date.issued2022-12-02-
dc.identifier.citationJournal of Bone and Joint Surgery, 2022, v. 105, n. 3, p. 181-190-
dc.identifier.issn0021-9355-
dc.identifier.urihttp://hdl.handle.net/10722/330987-
dc.description.abstract<h3>Background: </h3><p>Long-term data on postoperative neurological survivorship for patients with degenerative cervical myelopathy (DCM) undergoing decompressive surgery are limited. The purposes of this study were to assess neurological survivorship after primary decompressive surgery for DCM and to identify predictors for postoperative deterioration.</p><h3>Methods: </h3><p>A longitudinal clinical data set containing surgical details, medical comorbidities, and radiographic features was assembled for 195 patients who underwent a surgical procedure for DCM between 1999 and 2020, with a mean period of observation of 75.9 months. Kaplan-Meier curves were plotted, and a log-rank test was performed for the univariate analysis of factors related to neurological failure. Lasso regression facilitated the variable selection in the Cox proportional hazards model for multivariate analysis.</p><h3>Results: </h3><p>The overall neurological survivorship was 89.3% at 5 years and 77.3% at 10 years. Cox multivariate analysis following lasso regression identified elevated hazard ratios (HRs) for suture laminoplasty (HR, 4.76; p < 0.001), renal failure (HR, 4.43; p = 0.013), T2 hyperintensity (HR, 3.34; p = 0.05), and ossification of the posterior longitudinal ligament (OPLL) (HR, 2.32; p = 0.032). Subgroup analysis among subjects with OPLL demonstrated that the neurological failure rate was significantly higher in the absence of fusion (77.8% compared with 26.3%; p = 0.019).</p><h3>Conclusions: </h3><p>Overall, patients who underwent a surgical procedure for DCM exhibited an extended period with neurological improvement. Cervical fusion was indicated in OPLL to reduce neurological failure. Our findings on predictors for early deterioration facilitate case selection, prognostication, and counseling as the volume of primary cervical spine surgeries and reoperations increases globally.</p>-
dc.languageeng-
dc.publisherLippincott, Williams & Wilkins-
dc.relation.ispartofJournal of Bone and Joint Surgery-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.titleNeurological Survivorship Following Surgery for Degenerative Cervical Myelopathy: A Longitudinal Study on 195 Patients-
dc.typeArticle-
dc.identifier.doi10.2106/JBJS.22.00218-
dc.identifier.scopuseid_2-s2.0-85147235361-
dc.identifier.volume105-
dc.identifier.issue3-
dc.identifier.spage181-
dc.identifier.epage190-
dc.identifier.eissn1535-1386-
dc.identifier.isiWOS:000924605100006-
dc.identifier.issnl0021-9355-

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