Introduction: Surgery for the treatment of cervical spondylotic myelopathy (CSM) is generally safe and effective. Nonetheless complications do occur in 11-38% of patients. Knowledge of important clinical and surgical predictors of complications will help clinicians identify high-risk patients and institute appropriate prevention plans. To identify important clinical and surgical predictors of perioperative complications in patients with CSM.
Methods: Four-hundred and seventy-nine surgical CSM patients were enrolled in the prospective CSM-International study at sixteen global sites. A panel of physicians reviewed all adverse events and classified each one as either related or unrelated to surgery. Univariate analyses were performed to determine demographic and surgical differences between patients who experienced a perioperative complication and those who did not. A complication prediction rule was developed using multiple logistic regression.
Results: Seventy-eight patients experienced 89 perioperative complications (16.25%). Univariately, the major clinical risk factors were ossification of the posterior longitudinal ligament (OPLL) (p=0.055), the number of comorbidities (p=0.0018), co-morbidity score (p=0.0060), diabetes (p=0.0008), and co-existing gastrointestinal (p=0.039) and cardiovascular (p=0.046) disorders. Patients undergoing a two-stage surgery (p=0.0023) and those with a longer operative duration (p=0.0002) were also at a greater risk of perioperative complications. A final prediction model consisted of diabetes (OR=1.96, p=0.060), number of co-morbidities (OR=1.20, p=0.069), operative duration (OR=1.005, p=0.0015), and OPLL (OR=1.75, p=0.040).
Conclusions: Patients undergoing surgery for CSM are at a higher risk of perioperative complications if they have a greater number of co-morbidities, co-existing diabetes, OPLL and a longer operative duration. This information can be used by surgeons to discuss the risks and benefits of surgery with their patients; to plan case-specific preventive strategies; and to ensure appropriate management in the postoperative period.
Patient Care: This study aims to identify important clinical and surgical predictors of perioperative complications in patients with CSM.
Learning Objectives: To identify important clinical and surgical predictors of perioperative complications in patients with CSM.