Functional and clinical outcomes following surgical treatment in patients with cervical spondylotic myelopathy: a prospective study of 81 cases

Clinical article

Restricted access

Object

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.

Methods

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.

Results

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).

Conclusions

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.

Abbreviations used in this paper: BBS = Berg Balance Scale; CCI = Charlson Comorbidity Index; CSM = cervical spondylotic myelopathy; MCID = minimum clinically important difference; mJOA = modified Japanese Orthopaedic Association.

Article Information

Address correspondence to: Julio C. Furlan, M.D., Ph.D., 399 Bathurst Street, McL 12-407, Toronto, Ontario, Canada M5T 2S8. email: jcfurlan@gmail.com.

Please include this information when citing this paper: published online January 14, 2011; DOI: 10.3171/2010.10.SPINE091029.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Functional recovery at 6 months and 1 year following decompressive spine surgery for CSM as assessed by Nurick grade (A), mJOA score (B), and BBS score (C). * Significant difference based on an ANOVA with the Bonferroni post hoc test.

References

  • 1

    Baron EMYoung WF: Cervical spondylotic myelopathy: a brief review of its pathophysiology, clinical course, and diagnosis. Neurosurgery 60:1 Suppl 1S35S412007

    • Search Google Scholar
    • Export Citation
  • 2

    Bartels RHVerbeek ALGrotenhuis JA: Design of Lamifuse: a randomised, multi-centre controlled trial comparing laminectomy without or with dorsal fusion for cervical myeloradiculopathy. BMC Musculoskelet Disord 8:1112007

    • Search Google Scholar
    • Export Citation
  • 3

    Benzel ECLancon JKesterson LHadden T: Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:2862951991

    • Search Google Scholar
    • Export Citation
  • 4

    Berg KWood-Dauphinée SWilliams JIGayton D: Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 41:3043111989

    • Search Google Scholar
    • Export Citation
  • 5

    Berg KOWood-Dauphinee SLWilliams JIMaki B: Measuring balance in the elderly: validation of an instrument. Can J Public Health 83:Suppl 2S7S111992

    • Search Google Scholar
    • Export Citation
  • 6

    Boakye MPatil CGSantarelli JHo CTian WLad SP: Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery 62:4554622008

    • Search Google Scholar
    • Export Citation
  • 7

    Carreon LYPuno RMDimar JR IIGlassman SDJohnson JR: Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85-A:208920922003

    • Search Google Scholar
    • Export Citation
  • 8

    Charlson MEPompei PAles KLMacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:3733831987

    • Search Google Scholar
    • Export Citation
  • 9

    Cheung WYArvinte DWong YWLuk KDCheung KM: Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy—a prospective study. Int Orthop 32:2732782008

    • Search Google Scholar
    • Export Citation
  • 10

    Conradsson MLundin-Olsson LLindelöf NLittbrand HMalmqvist LGustafson Y: Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther 87:115511632007

    • Search Google Scholar
    • Export Citation
  • 11

    Deyo RACherkin DCLoeser JDBigos SJCiol MA: Morbidity and mortality in association with operations on the lumbar spine. The influence of age, diagnosis, and procedure. J Bone Joint Surg Am 74:5365431992

    • Search Google Scholar
    • Export Citation
  • 12

    Ebersold MJPare MCQuast LM: Surgical treatment for cervical spondylitic myelopathy. J Neurosurg 82:7457511995

  • 13

    Emery SE: Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg 9:3763882001

  • 14

    Fessler RGSteck JCGiovanini MA: Anterior cervical corpectomy for cervical spondylotic myelopathy. Neurosurgery 43:2572671998

  • 15

    Hukuda SMochizuki TOgata MShichikawa KShimomura Y: Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures. J Bone Joint Surg Br 67:6096151985

    • Search Google Scholar
    • Export Citation
  • 16

    King JT JrRoberts MS: Validity and reliability of the Short Form-36 in cervical spondylotic myelopathy. J Neurosurg 97:2 Suppl1801852002

    • Search Google Scholar
    • Export Citation
  • 17

    Lad SPPatil CGBerta SSantarelli JGHo CBoakye M: National trends in spinal fusion for cervical spondylotic myelopathy. Surg Neurol 71:66692009

    • Search Google Scholar
    • Export Citation
  • 18

    Lees FTurner JW: Natural history and prognosis of cervical spondylosis. BMJ 2:160716101963

  • 19

    Lu JWu XLi YKong X: Surgical results of anterior corpectomy in the aged patients with cervical myelopathy. Eur Spine J 17:1291352008

    • Search Google Scholar
    • Export Citation
  • 20

    Oldridge NBYuan ZStoll JERimm AR: Lumbar spine surgery and mortality among Medicare beneficiaries, 1986. Am J Public Health 84:129212981994

    • Search Google Scholar
    • Export Citation
  • 21

    Raffo CSLauerman WC: Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 31:991032006

    • Search Google Scholar
    • Export Citation
  • 22

    Riddle DLStratford PW: Interpreting validity indexes for diagnostic tests: an illustration using the Berg balance test. Phys Ther 79:9399481999

    • Search Google Scholar
    • Export Citation
  • 23

    Saunders RLBernini PMShirreffs TG JrReeves AG: Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:1631701991

    • Search Google Scholar
    • Export Citation
  • 24

    Shumway-Cook ABaldwin MPolissar NLGruber W: Predicting the probability for falls in community-dwelling older adults. Phys Ther 77:8128191997

    • Search Google Scholar
    • Export Citation
  • 25

    Singh ACrockard HA: Comparison of seven different scales used to quantify severity of cervical spondylotic myelopathy and post-operative improvement. J Outcome Meas 5:7988182002

    • Search Google Scholar
    • Export Citation
  • 26

    Singh ACrockard HAPlatts AStevens J: Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg 94:2 Suppl1891982001

    • Search Google Scholar
    • Export Citation
  • 27

    Steffen TSeney M: Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 88:7337462008

    • Search Google Scholar
    • Export Citation
  • 28

    Stevenson TJ: Detecting change in patients with stroke using the Berg Balance Scale. Aust J Physiother 47:29382001

  • 29

    Stucki G: International Classification of Functioning, Disability, and Health (ICF): a promising framework and classification for rehabilitation medicine. Am J Phys Med Rehabil 84:7337402005

    • Search Google Scholar
    • Export Citation
  • 30

    Tabachnick BGFidell LS: Using Multivariate Statistics ed 4BostonAllyn & Bacon2000

  • 31

    Wang MCChan LMaiman DJKreuter WDeyo RA: Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine 32:3423472007

    • Search Google Scholar
    • Export Citation
  • 32

    Yamazaki TYanaka KSato HUemura KTsukada ANose T: Cervical spondylotic myelopathy: surgical results and factors affecting outcome with special reference to age differences. Neurosurgery 52:1221262003

    • Search Google Scholar
    • Export Citation
  • 33

    Yonenobu KHosono NIwasaki MAsano MOno K: Neurologic complications of surgery for cervical compression myelopathy. Spine 16:127712821991

    • Search Google Scholar
    • Export Citation
  • 34

    Zeidman SMDucker TBRaycroft J: Trends and complications in cervical spine surgery: 1989–1993. J Spinal Disord 10:5235261997

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 286 287 22
Full Text Views 78 73 2
PDF Downloads 130 107 2
EPUB Downloads 0 0 0

PubMed

Google Scholar