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  • The Relationship Between Gastrointestinal Comorbidities, Clinical Presentation and Surgical Outcome in Patients with DCM: Analysis of a Global Cohort

    Final Number:

    Aria Nouri MD MSc; So Kato; Hamed Reihani-Kermani MD; Kishan Patel; Mohamed Saleh MD; Daniel M. Sciubba MD; Joseph S. Cheng MD MS; Michael G. Fehlings MD PhD FRCS(C) FACS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Degenerative Cervical Myelopathy (DCM) presents most frequently in patients 50 years or older. Gastrointestinal comorbidities (GIC) commonly occur in this group, however, their relationship with DCM has not been thoroughly investigated. Herein, we investigate the difference between patients with or without GICs who are surgically treated for DCM.

    Methods: 757 patients with clinical data and 458 with MRI data from the AOSpine-North America and AOSpine-International study on DCM were evaluated. GICs were obtained at presentation and included gastric, intestinal, hepatic and pancreatic conditions. Patients were dichotomized into 2 groups: with GIC and without GIC. Clinical and MRI presentation, and baseline neurological and functional status were compared. Neurological and functional outcome at 2-years follow-up were also compared.

    Results: GICs were present in 121 patients (16%). These patients were less commonly male (48.76% vs 65.4%, p=0.001), were slightly less neurologically impaired based on Nurick grade (3.05?1.10 vs 3.28?1.16, p=0.044) but not based on mJOA (12.74?2.62 vs 12.48?2.76, p=0.33), had a worse general heath score (71.27?16.88 vs 75.22?17.08, p=0.022), and worse neck disability (46.31?20.04 vs 38.23?20.44, p<0.001), and a lower prevalence of upper motor neuron signs (hyperreflexia, 70.2% vs 78.9%, p=0.037; Babinski’s sign 24.8% vs 37.3%, p=0.008). On MRI, GIC patients less commonly exhibited signal intensity changes (T2 hyperintensity, 49.2% vs 75.6%, p<0.001; T1 hypointensity, 9.7% vs 21.1%, p=0.036) and had a lower number of T2 hyperintensity levels (0.82?0.98 vs 1.3?1.11, p=0.001). There was no difference in surgical outcome.

    Conclusions: Patients with GICs are more likely to be female and have significantly more general health disability. However, these patients have less clinical and MRI features consistent with severe neurological impairment. This constellation of symptoms is considerably different than that typically observed in DCM and it is therefore plausible that nutritional factors including B12 deficiency which frequently manifests in elderly patients may contribute to this unique observation.

    Patient Care: There is little research on patients with gastrointestinal comorbidities in the setting of DCM. To the best of our knowledge this is the first study to comprehensively investigate the influence of gastrointestinal comorbidities on clinical presentation and surgical outcome. Our findings demonstrate that these patients are more commonly female and present with more severe general disability. However, its presence does not appear to impact surgical outcome. REYNOLDS, E. 2006. Vitamin B12, folic acid, and the nervous system. Lancet Neurol, 5, 949-60.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of the presents of gastrointestinal comorbidities in patients with DCM with regards to clinical presentation and surgical outcome. 2) Discuss, in small groups how gastrointestinal comorbidities impacts clinical management. 3) Identify an effective treatment strategy for dealing with gastrointestinal comorbidities in the setting of DCM.

    References: NOURI, A., PATEL, K., MONTEJO, J., NASSER, R., GIMBEL, D. A., SCIUBBA, D. M. & CHENG, J. S. 2018. The Role of Vitamin B12 in the Management and Optimization of Treatment in Patients with Degenerative Cervical Myelopathy. Global Spine J. GUAN, J., HOLLAND, C. M., RAVINDRA, V. M. & BISSON, E. F. 2017. Perioperative malnutrition and its relationship to length of stay and complications in patients undergoing surgery for cervical myelopathy. Surg Neurol Int, 8, 307.

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