TY - JOUR
T1 - Influence of Intervertebral Level of Stenosis on Neurological Recovery and Reduction of Neck Pain after Posterior Decompression Surgery for Cervical Spondylotic Myelopathy
T2 - A Retrospective Multicenter Study with Propensity Scoring
AU - Nori, Satoshi
AU - Nagoshi, Narihito
AU - Aoyama, Ryoma
AU - Ishihara, Shinichi
AU - Fujiyoshi, Kanehiro
AU - Shiono, Yuta
AU - Kitamura, Kazuya
AU - Ishikawa, Masayuki
AU - Suzuki, Satoshi
AU - Takahashi, Yohei
AU - Tsuji, Osahiko
AU - Yagi, Mitsuru
AU - Nakamura, Masaya
AU - Matsumoto, Morio
AU - Watanabe, Kota
AU - Ishii, Ken
AU - Yamane, Junichi
N1 - Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/3/15
Y1 - 2022/3/15
N2 - Study Design.Retrospective multicenter study.Objective.To identify the impact of the intervertebral level of stenosis on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).Summary of Background Data.As the upper affected cervical levels in elderly patients result from degenerative changes in the lower cervical levels with aging, it is usually difficult to determine the influence of the upper affected cervical levels on surgical outcomes after posterior decompression for CSM in older age.Methods.This study involved 636 patients with CSM who underwent posterior decompression. According to the most stenotic intervertebral level, patients were divided into upper (n = 343, the most stenotic intervertebral level was C2/3, C3/4, or C4/5) and lower (n = 293, the most stenotic intervertebral level was C5/6, C6/7, or C7/T1) cervical stenosis groups. Propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed to compare surgical outcomes, the Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for neck pain between the upper (n = 135) and lower (n = 135) cervical stenosis groups.Results.Before propensity score matching, age at surgery was older and pre- and postoperative JOA scores were lower in the upper cervical stenosis group (P < 0.001, P < 0.001, and P < 0.001, respectively). Following matching, baseline factors were comparable between the groups. Postoperative JOA scores, preoperative-to-postoperative changes in the JOA scores, and the JOA score recovery rate were not significantly different between the groups (P = 0.866, P = 0.825, and P = 0.753, respectively). No differences existed in postoperative VAS for neck pain and preoperative-to-postoperative changes in VAS for neck pain between the groups (P = 0.092 and P = 0.242, respectively).Conclusion.The intervertebral level of stenosis did not affect surgical outcomes after posterior decompression for CSM.Level of Evidence: 3.
AB - Study Design.Retrospective multicenter study.Objective.To identify the impact of the intervertebral level of stenosis on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).Summary of Background Data.As the upper affected cervical levels in elderly patients result from degenerative changes in the lower cervical levels with aging, it is usually difficult to determine the influence of the upper affected cervical levels on surgical outcomes after posterior decompression for CSM in older age.Methods.This study involved 636 patients with CSM who underwent posterior decompression. According to the most stenotic intervertebral level, patients were divided into upper (n = 343, the most stenotic intervertebral level was C2/3, C3/4, or C4/5) and lower (n = 293, the most stenotic intervertebral level was C5/6, C6/7, or C7/T1) cervical stenosis groups. Propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed to compare surgical outcomes, the Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for neck pain between the upper (n = 135) and lower (n = 135) cervical stenosis groups.Results.Before propensity score matching, age at surgery was older and pre- and postoperative JOA scores were lower in the upper cervical stenosis group (P < 0.001, P < 0.001, and P < 0.001, respectively). Following matching, baseline factors were comparable between the groups. Postoperative JOA scores, preoperative-to-postoperative changes in the JOA scores, and the JOA score recovery rate were not significantly different between the groups (P = 0.866, P = 0.825, and P = 0.753, respectively). No differences existed in postoperative VAS for neck pain and preoperative-to-postoperative changes in VAS for neck pain between the groups (P = 0.092 and P = 0.242, respectively).Conclusion.The intervertebral level of stenosis did not affect surgical outcomes after posterior decompression for CSM.Level of Evidence: 3.
KW - Cervical myelopathy
KW - Cervical spondylotic myelopathy
KW - Double-door laminoplasty
KW - Expansive open-door laminoplasty
KW - Intervertebral level of stenosis
KW - Japanese Orthopedic Association score
KW - Multicenter study
KW - Muscle-preserving selective laminectomy
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U2 - 10.1097/BRS.0000000000004270
DO - 10.1097/BRS.0000000000004270
M3 - Article
C2 - 34738987
AN - SCOPUS:85125552310
SN - 0362-2436
VL - 47
SP - 476
EP - 483
JO - Spine
JF - Spine
IS - 6
ER -