Abstract
Study design
Retrospective multicenter study.
Objectives
To identify the usefulness of the baseline severity of myelopathy for predicting surgical outcomes for cervical spondylotic myelopathy (CSM).
Setting
Seventeen institutions in Japan.
Methods
This study included 675 persons with CSM who underwent posterior decompression. According to baseline severity, the individuals were divided into the mild (Japanese Orthopaedic Association [JOA] score ≥ 14.5), moderate (JOA score = 10.5–14), and severe (JOA score ≤ 10) groups. Surgical outcomes and clinical variables were compared between the groups. Logistic regression analysis was used to develop a prediction model for unsatisfactory symptom state (postoperative JOA score ≤ 14, residual moderate or severe myelopathy).
Results
The mean (±standard deviation) age was 67 ± 12 years. The participants in the severe group were older than those in the mild group. Postoperative JOA scores were higher in the mild group than in the severe group. According to multivariate logistic regression analysis, the prediction model included preoperative JOA scores (odds ratio [OR] 0.60; 95% confidence interval [CI] 0.55–0.67) and age (OR 1.06, 95% CI 1.04–1.08). On the basis of the model, a representative combination of the thresholds to maximize the value of “sensitivity − (1 − specificity)” demonstrated a preoperative JOA score of 11.5 as a predictor of postoperative unsatisfactory symptom state in people around the mean age of the study cohort (67 years).
Conclusions
The combination of the baseline severity of myelopathy and age can predict postoperative symptom states after posterior decompression surgery for CSM.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
The authors acknowledge the contributions of the members of the participating institutions (Keio University School of Medicine, Isehara Kyodo Hospital, Saiseikai Yokohamashi Tobu Hospital, Fussa Hospital, Tokyo Saiseikai Central Hospital, International University of Health and Welfare Mita Hospital, National Hospital Organization Murayama Medical Center, Tokyo Dental College Ichikawa General Hospital, Japan Community Health Care Organization Saitama Medical Center, Edogawa Hospital, Kawasaki Municipal Hospital, Kitasato University Kitasato Institute Hospital, Keiyu Orthopaedic Hospital, Japanese Red Cross Shizuoka Hospital, Nerima General Hospital, Hiratsuka City Hospital, and National Defense Medical College Hospital) for assistance with data collection.
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SN and NN designed the research; SN, RT, and RK analyzed the data; SN, NN, and RK wrote the paper; HK, YK, NI, KN, TT, and YH performed data collection; OT, SS, EO, MY, MN, MM, KW, KI, and JY supervised the study; and all authors reviewed and approved the manuscript.
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This study received ethical approval from the institutional review boards of the participating institutions. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.
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Nori, S., Nagoshi, N., Kono, H. et al. Baseline severity of myelopathy predicts neurological outcomes after posterior decompression surgery for cervical spondylotic myelopathy: a retrospective study. Spinal Cord 59, 547–553 (2021). https://doi.org/10.1038/s41393-020-00603-3
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DOI: https://doi.org/10.1038/s41393-020-00603-3
