Risk Factors for Rapidly Progressive Neurological Deterioration in Cervical Spondylotic Myelopathy

Abstract

Study Design. A retrospective single-center study. Objective. This study sought to clarify the risk factors and to evaluate the surgical outcome in patients with rapidly progressive cervical spondylotic myelopathy (rp-CSM). Summary of Background Data. CSM is a degenerative spine disease presenting a slow development of myelopathy. Some patients, however, show rapidly progressive neurological deterioration (especially gait disturbances) without any trauma. At present, there is little information about this condition. Methods. We studied 71 consecutive CSM patients (52 men, 19 women) with a mean age of 67.1 years, and the follow-up period was 1 year. Patients were divided into two groups: rp-CSM and chronic-CSM (c-CSM) groups. The Japanese Orthopaedic Association score and various clinical differences, including age, sex, comorbidity, the waiting period from symptomatic onset to surgery, cervical range of motion, and intramedullary MR T2-hyperintensity were analyzed, and independent risk factors were determined using a logistic regression analysis. Results. Eighteen of 71 patients (25.4%) were diagnosed with rp-CSM. There were no significant differences between the two groups with regard to age, sex, or cervical range of motion. In the rp-CSM group, the preoperative upper/lower extremities and bladder functions were worse, and the waiting period for surgery was shorter (rp-CSM 1.2 mo, c-CSM 25.7 mo). Patients with rp-CSM had a history of cardiovascular event (CVE) (rp-CSM 44.4%, c-CSM 15.1%) and presented with MR T2-hyperintensity (rp-CSM 94.4%, c-CSM 58.5%), especially at the C4/5 disc level. Independent risk factors were a history of CVE (odds ratio = 4.7) and MR T2-hyperintensity (odds ratio = 12.5). The rp-CSM group showed a better neurological recovery after decompression surgery (the Japanese Orthopaedic Association recovery rate: rp-CSM 64.5%, c-CSM 40.7%). Conclusion. A history of CVE and MR T2-hyperintensity were risk factors for rp-CSM. Despite rapid neurological deterioration, rp-CSM patients showed a good neurological recovery after surgery, and thus indicating that rp-CSM is a reversible condition. Level of Evidence: 4

Outcome and predictive factors in rapid progressive cervical spondylotic myelopathy: A retrospective case-control study

“…The prognosis of patients with rapid progressive CSM is quite different among previous studies, Morishita reported that the preoperative JOA score is 5.4 and 9.6 at 1 year after surgery, which were signi cantly lower than in chronic CSM which were 10.1 and 12.9, respectively, and they concluded that prognosis of rp-CSM group was inferior than those in c-CSM group [3]. However, in the study of Takasawa [4] , JOA score was 5.7 preoperative and 12.9 after one year surgery (improvement rate was 64.5%) in rp-CSM group and 10.1 preoperative and 12.8 after one year surgery (improvement rate was 40.7%) in c-CSM, they reached a conclusion that patients with rp-CSM can get better recovery than those in c-CSM. In present study, The mJOA scores in rp-CSM group and c-CSM group were 6 and 12 before surgery, 8 and 14 at 1 week, 9 and 14 at 1 month, 10 and 15 at 3 month, 12 and 15 at 6 month and 12 and 15 at 1 year after surgery, respectively ,the mJOA scores at each follow-up time points in rp-CSM were signi cantly lower than those in c-CSM group.…”

“…Previous studies have shown that 82% and 56% of CSM patients will not experience severe neurological deterioration 5 years and 10 years after systematic conservative treatment [2]. However, neurological function of some CSM patients develop to severe dysfunction (such as unable to button shirt or walk) in a very short time without any trauma, which called in previous studies as rapid progressive CSM (rp-CSM) [3][4][5].…”

“…Although the speci c pathological mechanism of CSM is still unclear, it is closely related to spinal cord ischemia has widely recognized [6][7][8][9]. There have been studies about the natural course of CSM, and the chronic exacerbation of CCM and it has been reported that rapid neurological deterioration is associated with increased signal intensity (ISI), advanced age and anterior spondylolisthesis [4,5]. Acute exacerbation has yet to be studied clearly, it is necessary to carry out further study which combined more objective clinical scales and radiographic measurement.…”

Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy

“…The cases of patients visiting our hospital between January 2010 and January 2014 were retrospectively reviewed. rp-CSP was defined as when the patients had a course of CSM less than 1 month and suffered rapidly progressive neurological deterioration, causing difficulty in maintaining a standing posture or walking without support [4,5]. c-CSM was defined as when the patients had a course of CSM of more than 1 month [4,5].…”

“…A few patients with CSM suffered rapidly progressive neurological deterioration, particularly with walking disorders. Compared with chronic CSM (c-CSM), there have been few reports on the characteristics of rapidly progressive CSM (rp-CSM) [4,5]. Therefore, it is important for us to recognize rp-CSM and the pathogenesis of rp-CSM.…”