Journal List > J Korean Soc Spine Surg > v.23(2) > 1076123

Kim, Seo, and Lee: Factors Associated with Early Postoperative Complications in Patients with Cervical Spondylotic Myelopathy


Study Design



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.


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.


Factors associated with early postoperative complications for CSM are operative duration, compression ratio at the level of maximal cord compression on MRI, and cord signal intensity change on T2-weighted MRI.


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Table 1.
Complications following surgery for cervical spondylotic myelo-path
Complication Number of cases(%)
Delirium 1(1.9%)
Dysphagia 1(1.9%)
Hematoma 1(1.9%)
Motor weakness 3(5.9%)
Pneumonia 2(3.9%)
Pulmonary thromboembolism 1(1.9%)
Sacral sore 1(1.9%)
Seizure 1(1.9%)
Superficial wound infection 1(1.9%)
Wound dehiscence 1(1.9%)
Total 13(23.5%)
Table 2.
Demographic data
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%)  

JOA: Japanese Orthopedic Association

MI: myocardial infarct

CVA: cerebrovascular accident.

Table 3.
Factors affecting complications following surgery for cervical spondylotic myelopathy
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%)  

EBL: estimated blood loss

OPLL: ossification of posterior longitudinal ligament

MRI: magnetic resonance imaging

§ ACDF: anterior cervical discectomy and fusion

PD&PLF: posterior decompression and posterolateral fusion.

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