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Predictors of poor clinical outcome in patients with cervical spondylotic myelopathy undergoing cervical laminectomy and fusion

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Abstract

Background

Cervical spondylotic myelopathy (CSM) is a common degenerative disease that arises from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is one of the most common approaches used to treat patients with CSM. The present study aimed to evaluate predictors of poor clinical outcome in patients with CSM undergoing LPSF.

Methods

We retrospectively evaluated 157 patients with CSM who underwent LPSF at our center between April 2014 and June 2019. The neurological outcome was assessed using the modified Japanese Orthopaedic Association (mJOA) scale before the surgery and at the last follow-up visit. Based on the clinical outcomes, all patients were divided into two groups [the good group (recovery rates ≥ 75%) and the poor group (recovery rates < 75%)]. The following suggested variables as potential predictors for the poor clinical outcome were compared between the two groups:age, gender, body mass index (BMI), smoking, diabetes, number of laminectomy levels, presence of signal changes in Magnetic Resonance Imaging (MRI), duration of symptoms, preoperative JOA scale, preoperative Pavlov ratio, preoperative cervical curvature, and preoperative cervical range of motion (ROM).

Results

There were 86 males (54.8%) and 71 females (45.2%) with the mean follow-up time of 24.96 ± 1.67 months. Overall, 114 patients (72.6%) had a good clinical outcome. However, 43 subjects (27.4%) failed to achieve a good outcome. According to the binary logistic regression analysis, age (odds ratio [OR], 2.14; 95% confidence interval [95% CI], 1.87–2.63; P = 0.014) and preoperative JOA scale (OR, 3.73; 95% CI 2.96–4.87; p < 0.001) were independent predictors of poor clinical outcome.

Conclusions

The results of the present study showed that age and preoperative JOA scale were predictors of poor clinical outcome in patients with CSM undergoing LPSF. These findings will be of great value in preoperative counseling and management of postoperative expectations.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due them containing information that could compromise research participant privacy/consent but are available from the corresponding author on reasonable request. All data are available from the corresponding author upon reasonable request. The patient's data included in this manuscript has not been previously reported.

Abbreviations

CSM:

Cervical spondylotic myelopathy

LPSF:

Laminectomy with posterior spinal fusion

JOA:

Japanese Orthopaedic Association

BMI:

Body mass index

MRI:

Magnetic Resonance Imaging

ROM:

Cervical range of motion

HRQOL:

Health-related quality of life

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Acknowledgements

We appreciate the clinical Research Development Center of Imam Reza Hospital for their wise advice.

Funding

There was no external source of funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Kermanshah University of Medical Sciences, Kermanshah, Iran

    Farid Moradi, Seyed Reza Bagheri, Hamidreza Saeidiborojeni, Sepideh Amirian, Akram Amiri & Ehsan Alimohammadi

  2. Wayne State University School of Medicine, Detroit, USA

    Sonia V. Eden & Shafi Hamid

  3. Clinical Research Development Center, Imam Reza Hospital Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran

    Mobin Naderi

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  1. Farid Moradi
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  2. Seyed Reza Bagheri
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Contributions

EA, MN, HS, and SRB had the idea for this study. EA, AA, HS, and SA participated in outlining the concept and design. MN, SA, and AA did the data acquisition. EA, SVE, and SH did the statistical analysis and wrote the first draft of the manuscript. EA, SVE, SH, SA, and HS revised the final manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Ehsan Alimohammadi.

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All authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The study received ethics approval by the Kermanshah University of Medical Science Ethics Committee. Written informed consent to participate was obtained from all patients. All methods were carried out in accordance with relevant guidelines and regulations.

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Moradi, F., Bagheri, S.R., Saeidiborojeni, H. et al. Predictors of poor clinical outcome in patients with cervical spondylotic myelopathy undergoing cervical laminectomy and fusion. Musculoskelet Surg 107, 77–83 (2023). https://doi.org/10.1007/s12306-021-00731-w

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