Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

Background The rapid progressive cervical spondylotic myelopathy (rp-CSM) which had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration had few reports. Therefore, it is important for us to recognize the pathophysiology of CSM especially the rp-CSM. The stud...

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Published in:Journal of orthopaedic surgery and research Vol. 16; no. 1; pp. 75 - 4
Main Authors: Zhong, Weiyang, Wang, Lin, Huang, Tianji, Luo, Xiaoji
Format: Journal Article
Language:English
Published: London BioMed Central 21.01.2021
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Central nervous system diseases
Cervical spondylotic myelopathy
Decompression
Diabetes
Diabetes mellitus
Edema
Genetic disorders
Health aspects
Hospitals
Hypertension
Ischemia
Magnetic resonance imaging
Medical research
Medicine
Medicine & Public Health
Medicine, Experimental
MR T2-hyperintensity
Orthopedics
Ossification
Pathogenesis
Patients
Regression analysis
Research Article
Risk factor
Risk factors
Spinal cord
Spinal cord injuries
Spinal stenosis
Surgeons
Surgery
Surgical Orthopedics
Trauma
MR T2-hyperintensity
Cervical spondylotic myelopathy
Risk factor
ISSN:1749-799X, 1749-799X
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Summary:Background The rapid progressive cervical spondylotic myelopathy (rp-CSM) which had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration had few reports. Therefore, it is important for us to recognize the pathophysiology of CSM especially the rp-CSM. The study aimed to investigate the risk factors for rapidly progressive (rp) neurological deterioration in patients with cervical spondylotic myelopathy (CSM). Methods A total of 159 patients were reviewed and divided into an rp-CSM group and a chronic-CSM (c-CSM) group. Various clinical indexes, including age, sex, Japanese Orthopaedic Association (JOA) score, intramedullary MR T2-hyperintensity, congenital/degenerative spinal stenosis, and local type of ossification of the posterior longitudinal ligament (OPLL), were analyzed, and independent risk factors were investigated. Results Thirty-four of 159 patients (21.4%) were diagnosed with rp-CSM. All patients were followed up for a mean of 68.56 ± 14.00 months in the rp-CSM group and 62.66 ± 19.95 months in the c-CSM group. No significant difference was found in sex, mean age, smoking and drinking status, diabetes mellitus (DM), hypertension, surgery time, blood loss, JOA score, degenerative spinal stenosis, or OPLL (local). Univariate analyses demonstrated that rp-CSM patients tended to have MR T2-hyperintensity, longer hospital stay, shorter waiting time for surgery, more congenital spinal stenosis, and worse neurological function and to prefer more posterior surgeries than c-CSM patients. A multiple logistic regression analysis showed that congenital spinal stenosis and MR T2-hyperintensity were independently related to the presence of rp-CSM. Conclusions MR T2-hyperintensity and congenital spinal stenosis were risk factors for rp-CSM. Although neurological function deteriorates rapidly, early surgical decompression is recommended and can achieve good neurological recovery after surgery, indicating that rp-CSM could be a reversible condition.
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ISSN:1749-799X
1749-799X
DOI:10.1186/s13018-021-02227-6