Predictors of poor outcome in cervical spondylotic myelopathy patients underwent anterior hybrid approach: focusing on change of local kyphosis

Abstract

Object: This study was a retrospective multivariable analysis for risk factors of poor outcome in patients underwent anterior hybrid approach, and discussed the causes of worsening of postoperative local alignment.Methods: A total of 86 patients with progressive spinal cord compression and local kyphosis underwent an anterior hybrid approach (ACDF+ACCF), between June 2011 and June 2017. We evaluated clinical outcome by the Japanese Orthopaedic Association (JOA) score and recovery rate. Patients were divided into two groups according to worsening and improving of postoperative local alignment. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were applied to the evaluation of risk factors. Mann–Whitney U-test, Independent t-test and Chi-squared test was performed for the comparison of local kyphosis between postoperative and last follow-up.Results: There were twenty patients who had a recovery rate of less than 50%. Advance age, longer duration of symptoms, bigger T1 slope angle and lower change of local kyphosis angle was significantly associated with a poor clinical outcome by multivariate logistic regression analysis. The ROC curve showed that the cutoff values of change of local angle between preoperative and last follow-up was 10.2 angle. The cause of worsening of postoperative local alignment had T1 slope, C2-7 sagittal vertical axis (SVA), adjacent segment degeneration (ASD), and implant subsidence.Conclusions: The change of local kyphosis was a predictor of clinical outcome after the hybrid approach. Furthermore, postoperative ASD, implant subsidence, T1 slope and C2-7 Cobb were associated with recurrence of postoperative cervical kyphosis.

Predictors for quality of life improvement after surgery for degenerative cervical myelopathy: a prospective multi-center study

“…8 Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan. 9 Department of Orthopedic Surgery, Imakiire General Hospital, Kagoshima-shi, Japan.…”

“…However, it remains unclear which patients experience poor QOL improvement after surgery. To date, most of the reports on surgical outcomes have used the Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA) to evaluate neurological status [7][8][9]. However, based on international assessment standards, there are several problems associated with C-JOA scores including that (1) they do not reflect the patient's self-assessment of pain, numbness, and health status and (2) they are assessed primarily from the physician's perspective [10].…”