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Cervical arteriosclerosis is associated with preoperative clinical symptoms in patients with cervical spondylotic myelopathy

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Abstract

Purpose

This study aims to clarify the association between cervical spondylotic myelopathy (CSM) and cervical arteriosclerosis using ultrasonography that comprehensively includes spinal cord stenosis.

Methods

Eighty-two consecutive patients aged over 60 years who underwent spine surgery were divided into those with CSM (n = 31; CSM group) and those with lumbar spinal stenosis without cervical myelopathy (n = 51; LSS group). Maximum spinal cord compression (MSCC) was evaluated for cervical stenosis severity using magnetic resonance (MR) images. The intima–media thickness (IMT) of the common carotid artery (CCA) and pulsatility index (PI) of the bilateral internal carotid artery (ICA) and vertebral artery (VA) were evaluated for cervical arteriosclerosis using pulsed-wave Doppler ultrasonography. Symptom severity was evaluated using the Japanese Orthopaedic Association (JOA) score. Spearman’s correlation coefficient was used to determine the relationship between the JOA score and MSCC or IMT and PI in each group. Stepwise multiple linear regression analyses were conducted with the JOA score as a dependent variable and age, sex, body mass index, cervical arteriosclerosis assessment, and MSCC as independent variables.

Results

Bilateral IMT and left-side ICA-PI were significantly negatively correlated with JOA scores in the CSM group (Right-CCA-IMT: R =  − 0.412, Left-IMT: R =  − 0.549, Left-ICA -PI: R =  − 0.205, P < 0.05), but not in the LSS group. Multiple linear regression analyses showed that CCA-IMT was the strongest independent factor associated with the preoperative JOA score.

Conclusions

Cervical arteriosclerosis was associated with preoperative clinical symptoms in CSM patients.

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Acknowledgements

This study was supported by Dr Toshihiro Tanaka from the Department of Orthopaedic Surgery, Takaoka Seishikai Hospital, Toyama, Japan and Dr Hitoshi Kudo from the Department of Orthopaedic Surgery, Mutsu General Hospital, Aomori, Japan. We would like to thank Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

    Gentaro Kumagai, Kanichiro Wada, Sunao Tanaka, Toru Asari & Yasuyuki Ishibashi

Authors
  1. Gentaro Kumagai
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  2. Kanichiro Wada
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  3. Sunao Tanaka
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  4. Toru Asari
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  5. Yasuyuki Ishibashi
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Contributions

GK, KW, and YI conceived and designed the experiments; GK, WK, ST, and TA performed the experiments; and GK analyzed the data and wrote the paper.

Corresponding author

Correspondence to Gentaro Kumagai.

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The authors have no relevant financial or non-financial interests to disclose.

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This study was approved by the institutional ethics committee.

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Kumagai, G., Wada, K., Tanaka, S. et al. Cervical arteriosclerosis is associated with preoperative clinical symptoms in patients with cervical spondylotic myelopathy. Eur Spine J 30, 547–553 (2021). https://doi.org/10.1007/s00586-020-06649-4

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  • DOI: https://doi.org/10.1007/s00586-020-06649-4

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