Neck injury, bone spurs, herniated disks, and rheumatoid arthritis manifesting in the cervical spine can all result in spine compression which in some cases leads to cervical spondylotic myelopathy (CSM). This condition, more prevalent in patients age 50 and over, is manifested by altered balance and coordination, weakness in the upper limbs, loss of fine motor skills, and neck pain due to spinal compression.

Altered reflexes (hyperreflexia in particular), loss of balance, weakness in the legs, muscle atrophy and a history of weakness and numbness of fingers, hands, or arms warrant further investigation to assess presence of cervical spine compression using X-rays, MRI or CT scans, or myelogram.

High Yield Data Summary

  • Diabetes mellitus, number of comorbidities, duration of surgery, and ossification of the posterior longitudinal ligament were associated with increased risk of perioperative complications in CSM

In mild cases of CSM, non-surgical treatments might be successful in alleviating pain. Chiropractic manipulation, however, is contra-indicated for spinal cord compression. If those non-surgical interventions prove ineffective in relieving CSM-mediated pain, surgery is recommended.

In an article to appear next month in Neurosurgery, Michael Fehlings, MD, PhD, of Toronto Western Hospital and colleagues, sought to identify clinical and surgical parameters likely to predict perioperative complications which are observed in 11-38% of patients undergoing CSM surgery.1 

With these predictors, Dr Fehlings hopes to improve clinical management practices.

A team of physicians analyzed data from 479 patients enrolled in a prospective CSM study at 16 sites in 15 different countries. Univariate analyzes allowed to determine parameters distinguishing patients experiencing perioperative complications from others. 

Of the 479 patients whose data was analyzed, 78 (16.25%) showed a set of 89 perioperative complications. Major risk factors identified with the univariate analysis were diabetes mellitus (P=.001), number of comorbidities (P=.002), ossification of the posterior longitudinal ligament (OPLL, P=.055), comorbidity score (P=.006), gastrointestinal disorders (P=.039), and cardiovascular disorders (P= .046). In addition, perioperative complications were more prevalent in 2-stage surgeries (P=.002) and longer operations (P=.001).

In their final prediction model, physicians retained the following parameters as having an impact on incidence of perioperative complications following CSM surgery: diabetes mellitus (odds ratio [OR]=1.96; P=.06), number of comorbidities (OR=1.20; P=.069), duration of surgery (OR=1.07; P= .002), and OPLL (OR=1.75; P=.04).

Summary and Clinical Applicability

This study should help identify CSM patients at higher risks of developing perioperative complications, and to anticipate these by taking preventive measures, and closely monitoring patients. 

Authors hope “surgeons [will] use this information to discuss the risks and benefits of surgery with patients, to plan case-specific preventive strategies, and to ensure appropriate management in the perioperative period.”

Reference

1. Tetreault L, Tan G, Kopjar B, et al. Clinical and surgical predictors of complications following surgery for the treatment of cervical spondylotic myelopathy: results From the multicenter, prospective AOSpine International Study of 479 patients. Neurosurgery. 2016 79(1):33-44. doi: 10.1227/NEU.0000000000001151.

This article originally appeared on Clinical Pain Advisor