Predictors of morbidity and mortality among patients with cervical spondylotic myelopathy treated surgically

Kaye, I. David; Marascalchi, Bryan J.; Macagno, Angel; Lafage, Virginie; Bendo, John A.; Passias, Peter G.

doi:10.1007/s00586-015-4010-2

Cited by 31 publications

(12 citation statements)

References 24 publications

(30 reference statements)

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“…In addition to obesity, weight loss has also been shown to affect surgical prognosis; ‘pathological weight loss’, defined as greater than 10% of body weight within 6 months of surgery, has been shown to be a predictor of 30-day hospital readmission in patients undergoing PCF. 41 Similarly, pathological weight loss was found to significantly increase surgical mortality rate, 40 and to be a significant predictor of aspiration. 42 …”

Section: Resultsmentioning

confidence: 94%

“…On the contrary, 1 study reported that obesity was associated with a decreased risk of mortality and a higher functional independence in surgical DCM patients. 40 Another study reported greater mental-state-improvement post-operatively in obese patients. 31 Other studies found that both mental and physical improvements were poorer in obese patients compared to non-obese patients after anterior cervical surgery.…”

Section: Resultsmentioning

confidence: 98%

“…Nutritional status is a significant predictor of length of hospital stay and post-operative functional motor independence. 45 Fluid and electrolyte disturbances have been shown to be significant predictors of perioperative morbidity, 40 post-operative aspiration 45 and post-operative dysphagia in patients undergoing anterior cervical fusion. 46 Furthermore, dehydration has been shown to be a significant predictor for 30-day hospital readmission after PCF.…”

Section: Resultsmentioning

confidence: 99%

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The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Partha-Sarathi

Mowforth

Sinha

et al. 2021

Nutr Metab Insights

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Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

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The Role of Nutrition in Degenerative Cervical Myelopathy: A Systematic Review

Partha-Sarathi

Mowforth

Sinha

et al. 2021

Nutr Metab Insights

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“…[24] Private insurance status was found to be a predictor of anterior cervical fusions for the treatment of CSM, which was also found to be the approach with the lowest mortality. [416] The increased use of fusion surgery in patients with private insurance could be explained by the increased rate of collection of hospital charges from private payers in comparison to Medicare/Medicaid. [18]…”

Section: Discussionmentioning

confidence: 99%

“…[12] Another recent study indicated that posterior-only approaches are associated with a higher rate if mortality, which might also explain the decreased utilization of posterior approaches as compared to anterior fusions. [4]…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic and regional differences in the treatment of cervical spondylotic myelopathy

Palejwala¹,

Rughani²,

Lemole³

et al. 2017

Surg Neurol Int

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Background:Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord dysfunction in the world. Surgical treatment is both medically and economically advantageous, and can be achieved through multiple approaches, with or without fusion. We used the Nationwide Inpatient Sample (NIS) database to better elucidate regional and socioeconomic variances in the treatment of CSM.Methods:The NIS database was queried for elective admissions with a primary diagnosis of CSM (ICD-9 721.1). This was evaluated for patients who also carried a diagnosis of anterior (ICD-9 81.02) or posterior cervical fusion (ICD-9 81.03), posterior cervical laminectomy (ICD 03.09), or a combination. We then investigated variances including regional trends and disparities according to hospital and insurance types.Results:During 2002–2012, 50605 patients were electively admitted with a diagnosis of CSM. Anterior fusions were more common in Midwestern states and in nonteaching hospitals. Fusion procedures were used more frequently than other treatments in private hospitals and with private insurance. Median hospital charges were also expectedly higher for fusion procedures and combined surgical approaches. Combined approaches were found to be significantly greater in patients with concurrent diagnoses of ossification of the posterior longitudinal ligament (OPLL) and CSM. Ultimately, there has been an increased utilization of fusion procedures versus nonfusion treatments, over the past decade, for patients with cervical myelopathy.Conclusions:Fusion surgery is being increasingly used for the treatment of CSM. Expensive procedures are being performed more frequently in both private hospitals and for those with private insurance, whereas the most economical procedure, posterior cervical laminectomy, was underutilized.

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