A new model has been developed to assist in the prediction of possible complications following surgery for cervical spondylotic myelopathy (CSM), a common condition causing compression of the spinal cord in the neck. The model identifies 4 factors that are associated with elevated risk for postsurgical complications and is derived from an international study of 479 patients who underwent surgery for CSM. A total of 89 incidences of surgical complication, in 78 patients, were identified. The researchers, from Toronto Western Hospital, considered a wide range of clinical and surgical factors and applied a “complication prediction rule” to narrow and identify those most likely to associate with postprocedure complications. The study is reported in the July issue of Neurosurgery.
CSM is the most common cause of spinal cord dysfunction in the elderly. Patients with CSM may experience pain and stiffness in the neck, as well as numbness and weakness in the arms and legs, arising from pressure on the spinal cord or nerve roots. Surgery has proven significantly effective in halting progression of these symptoms and improving patients’ quality of life, but complications from the procedure occur in 11% to 38% of patients. The 2 most prominent predictors of complication, according to the study, are the presence of ossification of the posterior longitudinal ligament (OPLL), and/or pre-existing diabetes. Additional factors contributing to risk of complication include other pre-existing medical conditions such as cardiovascular disease, and longer duration of surgery. The researchers conclude, "Surgeons can use this information to discuss the risks and benefits of surgery with patients, to plan case-specific preventive strategies, and to ensure appropriate management in the perioperative period."
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A news story about the recommendations, with link to the journal article, may be read here.