Abstract
Objectives
To investigate factors related to early postoperative complications of surgery for cervical spondylotic myelopathy (CSM).
Summary of Literature Review
Factors associated with increased risk of complications from surgery for CSM are greater age, greater estimated blood loss, longer operative duration, and anterior-posterior combined procedures.
Materials and Methods
The records of patients (male 32, female 19, mean age 61 years) who underwent surgery for CSM between November 2004 and December 2014 were investigated for early postoperative complications and potentially related factors. Factors considered were age, gender, duration of symptoms, diabetes, smoking, comorbidity, preoperative Japanese Orthopedic Association (JOA) score, numbers of cervical levels involved, ossification of the posterior longitudinal ligament (OPLL), operative approach, fusion, operative duration, estimated blood loss (EBL), maximal cord compression ratio on MRI, and cord signal intensity change on T2-weighted MRI.
Results
Early postoperative complications were observed in 12 of 51 patients and included motor weakness in 3, pneumonia in 2, and delirium, dysphagia, hematoma, pulmonary thromboembolism, sore, seizure, wound dehiscence, and superficial infection, each in 1. Factors associated with early postoperative complications were operative duration (p=0.024), maximal cord compression ratio on MRI (p=0.009), and cord signal intensity change on T2-weighted MRI (p=0.009). The other factors were not found to correlate significantly.
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Table 1.
Table 2.
Factor | Postoperative complication | p | ||
---|---|---|---|---|
No(%) | Yes(%) | |||
Age (years) | 59.9±10.7 | 65.8±14.2 | 0.125 | |
Gender | Male | 25(78.1%) | 7(21.9%) | 0.718 |
Female | 14(73.7%) | 5(26.3%) | ||
Preoperative ∗JOA | 11.9±2.0 | 12.2±3.6 | 0.766 | |
Duration of symptom (months) | < 1 | 2(100%) | 0(0%) | 0.628 |
1-6 | 16(72.7%) | 6(27.3%) | ||
6-12 | 6(66.7%) | 3(33.3%) | ||
>12 | 15(83.3%) | 3(16.7%) | ||
Co-morbidity | Hypertension | 14(70.0%) | 6(30.0%) | |
Diabetes | 8(80.0%) | 2(20.0%) | ||
Angina & †MI | 5(71.4%) | 2(28.6%) | ||
Hepatitis | 2(100%) | 0(0%) | ||
‡CVA | 1(50.0%) | 1(50.0%) | ||
Chronic kidney disease | 0(0%) | 2(100%) | ||
Asthma | 0(0%) | 1(100%) | ||
Gout | 1(100%) | 0(0%) | ||
Hypothyroidism | 0(0%) | 1(100%) | ||
Neurogenic bladder | 0(0%) | 1(100%) | ||
Alzheimer disease | 0(0%) | 1(100%) |
Table 3.
Factor | Postoperative complication | p | ||
---|---|---|---|---|
No(%) | Yes(%) | |||
Op. duration (minute) | 109.7±35.7 | 138.3±42.5 | 0.024 | |
∗EBL (ml) | 653.9±380.9 | 666.7±355.1 | 0.918 | |
Age (years) | <65 | 24(85.7%) | 4(14.3%) | 0.086 |
≥65 | 15(53.6%) | 8(28.6%) | ||
Fusion 여부 | No | 15(88.2%) | 2(11.8%) | 0.161 |
Yes | 24(70.6%) | 10(29.4%) | ||
†OPLL | No | 34(0.81) | 8(0.19) | 0.103 |
Yes | 5(0.556) | 4(0.444) | ||
Operative approach | Anterior | 15(93.8%) | 1(6.3%) | 0.828 |
Posterior | 24(68.6%) | 11(31.4%) | ||
Diabetes | No | 31(77.5) | 9(22.5) | 0.864 |
Yes | 8(80.0) | 2(20.0) | ||
Smoking | No | 34(77.3%) | 10(22.7%) | 0.735 |
Yes | 5(71.4%) | 2(28.6%) | ||
No. of involved cervical level | 1 | 14(93.3%) | 1(6.7%) | |
2 | 11(61.1%) | 7(38.9%) | ||
3 | 10(83.3%) | 2(16.7%) | 0.147 | |
4 | 4(66.7%) | 2(33.3%) | ||
Cord compression ratio on ‡MRI | 0.42±0.06 | 0.36±0.08 | 0.009 | |
Cord signal intensity change on T2 weighted ‡MRI | No | 39(79.6%) | 10(20.4%) | |
Yes | 0(0%) | 2(100%) | 0.009 | |
No. of co-morbidity | 0 | 17(81.0%) | 4(19.0%) | |
1 | 16(84.2%) | 3(15.8%) | ||
2 | 3(60.0%) | 2(40.0%) | 0.147 | |
>3 | 3(50.0%) | 3(50.0%) |