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

Abstract

Objective: This study was a retrospective multivariable analysis for risk factors of poor outcome in patients who 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 the worsening and improving of postoperative local alignment. Multivariate logistic regression analysis was applied to the evaluation of risk factors. Mann-Whitney U test, independent t test, and chi-squared test were 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 were significantly associated with a poor clinical outcome by multivariate logistic regression analysis. 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.

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

“…Experimental models of CSM have revealed that cervical kyphotic deformity is associated with demyelination, atrophy, and neuronal loss of the anterior horn, together with a decreased vascular supply of the anterior spinal cord [9,31]. Contrary to our results, a correlation between the CSM severity and the preoperative [32] or postoperative [33] local kyphotic deformity was found in recent studies.…”

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

“…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 – 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 ].…”

Predictive Nomogram for Clinical Prognosis in Cervical Spondylotic Myelopathy With Intramedullary T2-Weighted Increased Signal Intensity: A Novel Digital Tool for Patient Prognosis Education

“…Prognosis status was evaluated by a 6-month post-operative improvement rate for the JOA score. The calculation formula of the JOA improvement rate is as follows: the JOA improvement rate = (post-operative JOA score—pre-operative JOA score)/(17—pre-operative JOA score) × 100% ( 14 ). A JOA score improvement rate of more than 75% is excellent, 50–74% is good, 25–49% is acceptable, and <25% is poor ( 15 ).…”