4 Factors Increase Risk of Complications Following Surgery for Cervical Spondylotic Myelopathy
Non-surgical interventions are not always successful in relieving cervical spondylotic myelopathy-related pain.
Neck injury, bone spurs in the spine, herniated disks, and rheumatoid arthritis manifesting in the cervical spine can all result in spine compression which in some cases leads to cervical spondylotic myelopathy (CSM). This condition, which is more prevalent in patients age 50 and over, is manifested by altered balance and coordination, weakness and tingling/numbness in upper limbs, loss of fine motor skills, and neck pain, all resulting from interruption of nerve impulses due to spinal compression.
Altered reflexes (hyper-reflexia in particular), loss of balance, weakness in the legs, muscle atrophy and a history of weakness and numbness of fingers, hands and/or arms, all warrant further investigation to assess presence of cervical spine compression using X-rays, MRI or CT scans, or myelogram.
In mild cases of CSM, non-surgical treatments might be successful in alleviating pain. These include prescription of a cervical collar, physical therapy, and/or prescription drugs (e.g. NSAIDs, oral administration of corticosteroids, epidural injection of steroids, or narcotics). Chiropractic manipulation, however, is contra-indicated for spinal cord compression. If those non-surgical interventions prove ineffective in relieving CSM-mediated pain, surgery is recommended.
In an article to appear next month in Neurosurgery, Michael Fehlings, MD, PhD, of Toronto Western Hospital and colleagues, sought to identify clinical and surgical parameters likely to predict perioperative complications which are observed in 11-38% of patients undergoing CSM surgery.1 With these predictors, Dr Fehlings hopes to improve clinical management practices.
A team of physicians analyzed data from 479 patients enrolled in a prospective CSM study at 16 sites in 15 different countries, focusing on adverse events, (un)related to CSM surgery. Univariate analyzes allowed to determine parameters distinguishing patients experiencing perioperative complications from others. Of the 479 patients whose data was analyzed, 78 (16.25%) showed a set of 89 perioperative complications. Major risk factors identified with the univariate analysis were diabetes mellitus (p = .001), number of comorbidities (p =.002), ossification of the posterior longitudinal ligament (OPLL, p = .055), comorbidity score (p = .006), gastrointestinal disorders (p = .039), and cardiovascular disorders (p = .046). In addition, perioperative complications were more prevalent in 2-stage surgeries (p =.002) and longer operations (p =.001).
In their final prediction model, physicians retained the following parameters as having an impact on incidence of perioperative complications following CSM surgery: diabetes mellitus (odds ratio [OR]=1.96; p = .06), number of comorbidities (OR=1.20; p = .069), duration of surgery (OR=1.07; p = .002), and OPLL (OR=1.75; p =.04).
This study should help identify CSM patients at higher risks of developing perioperative complications, and to anticipate these by taking preventive measures, and closely monitoring patients. Authors hope “surgeons [will] use this information to discuss the risks and benefits of surgery with patients, to plan case-specific preventive strategies, and to ensure appropriate management in the perioperative period.”
1. Tetreault L, Tan G, Kopjar B, Côté P, Arnold P, Nugaeva N, Barbagallo G, Fehlings MG. Clinical and Surgical Predictors of Complications Following Surgery for the Treatment of Cervical Spondylotic Myelopathy: Results From the Multicenter, Prospective AOSpine International Study of 479 Patients. Neurosurgery. 2016;79(1):33-44.