J Korean Soc Spine Surg.  2016 Jun;23(2):77-83. 10.4184/jkss.2016.23.2.77.

Factors Associated with Early Postoperative Complications in Patients with Cervical Spondylotic Myelopathy

• Kim MW
• Seo JH
• Lee KY

• KMID: 2328000
• DOI: http://doi.org/10.4184/jkss.2016.23.2.77

Abstract

STUDY DESIGN: Retrospective.
OBJECTIVES
To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM). SUMMARY OF LITERATURE REVIEW: Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures.
MATERIALS AND METHODS
The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI.
RESULTS
Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly.
CONCLUSIONS
Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.

Keyword

Cervical; Myelopathy; Postoperative; Complication; Factor

MeSH Terms

Asian Continental Ancestry Group
Comorbidity
Deglutition Disorders
Delirium
Female
Hematoma
Humans
Longitudinal Ligaments
Magnetic Resonance Imaging
Orthopedics
Pneumonia
Postoperative Complications*
Pulmonary Embolism
Retrospective Studies
Seizures
Smoke
Smoking
Spinal Cord Diseases*
Wounds and Injuries
Smoke

Reference

1. Cunningham MR, Hershman S, Bendo J. Systematic review of cohort studies comparing surgical treatments for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2010; 35:537–43.

2. Klineberg E. Cervical spondylotic myelopathy: a review of the evidence. Orthop Clin North Am. 2010; 41:193–202.

3. Rao RD, Gourab K, David KS. Operative treatment of cervical spondylotic myelopathy. J Bone Joint Surg Am. 2006; 88:1619–40.

4. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010; 16:176–87.

5. Yagi M, Ninomiya K, Kihara M, et al. Long-term surgical outcome and risk factors in patients with cervical myelopathy and a change in signal intensity of intramedullary spinal cord on Magnetic Resonance imaging. J Neurosurg Spine. 2010; 12:59–65.

6. Edwards CC, Riew KD, Anderson PA, et al. Cervical myelopathy: current diagnostic and treatment strategies. The Spine Journal. 2003; 3:68–81.

7. Chang H. Cervical Spondylotic Myelopathy. J Korean Soc Spine Surg. 1999; 6:194–200.

8. Macagno A, Liu S, Marascalchi BJ, et al. Perioperative Risks Associated with Cervical Spondylotic Myelopathy Based on Surgical Treatment Strategies. Int J Spine Surg. 2015; 9:24.

9. Matz PG, Anderson PA, Holly LT, et al. The natural his-tory of cervical spondylotic myelopathy. J Neurosurg Spine. 2009; 11:104–11.

10. Sampath P, Bendebba M, Davis JD, et al. Outcome of patients treated for cervical myelopathy. A prospective, mul-ticenter study with independent clinical review. Spine (Phila Pa 1976). 2000; 25:670–6.

11. Fujiwara K, Yonenobu K, Ebara S, et al. The prognosis of surgery for cervical compression myelopathy. An analysis of the factors involved. J Bone Joint Surg Br. 1989; 71:393–8.

12. Handa Y, Kubota T, Ishii H, et al. Evaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A ret-rospective comparison with younger patients. J Neurosurg. 2002; 96:173–9.

13. Kohno K, Kumon Y, Oka Y, et al. Evaluation of prognostic factors following expansive laminoplasty for cervical spinal stenotic myelopathy. Surg Neurol. 1997; 48:237–45.

14. Morio Y, Teshima R, Nagashima H, et al. Correlation between operative outcomes of cervical compression myelopathy and mri of the spinal cord. Spine (Phila Pa 1976). 2001; 26:1238–45.

15. Tanaka J, Seki N, Tokimura F, et al. Operative results of canal-expansive laminoplasty for cervical spondylotic myelopathy in elderly patients. Spine (Phila Pa 1976). 1999; 24:2308–12.

16. Bapat MR, Chaudhary K, Sharma A, et al. Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases. Eur Spine J. 2008; 17:1651–63.

17. Bilbao G, Duart M, Aurrecoechea JJ, et al. Surgical results and complications in a series of 71 consecutive cervical spondylotic corpectomies. Acta Neurochir (Wien). 2010; 152:1155–63.

18. Nagano A, Miyamoto K, Hosoe H, et al. Surgical treatment for cervical myelopathy in patients aged > 80 years. orthopedics. 2004; 27:45–8.

19. Fehlings MG, Smith JS, Kopjar B, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine. 2012; 16:425–32.

20. Tetreault L, Ibrahim A, Cote P, et al. A systematic review of clinical and surgical predictors of complications following surgery for degenerative cervical myelopathy. J Neurosurg Spine. 2015. 1–23.

21. Nagata K, Ohashi T, Abe J, et al. Cervical myelopathy in elderly patients: clinical results and MRI findings before and after decompression surgery. Spinal Cord. 1996; 34:220–6.

22. Nagashima H, Dokai T, Hashiguchi H, et al. Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80 years or older: a multi-center retrospective study. Eur Spine J. 2011; 20:240–6.

23. Boakye M, Patil CG, Santarelli J, et al. Cervical spondylotic myelopathy: complications and outcomes after spinal fusion. Neurosurgery. 2008; 62:455–61.

24. Chiba K, Toyama Y, Matsumoto M, et al. Segmental motor paralysis after expansive open-door laminoplasty. Spine (Phila Pa 1976). 2002; 27:2108–15.