Surgical outcomes of elderly patients with cervical spondylotic myelopathy.

BACKGROUND: Cervical spondylotic myelopathy is a potentially serious neurologic disorder that commonly presents with gait difficulty and hand dysfunction. Because the development of CSM is in large part related to advanced spondylosis and degenerative disk disease, elderly patients appear to be at an increased risk to develop this condition. The surgical outcomes of this patient population have been understudied; the authors seek to report their clinical results in a series of patients with CSM older than 75 years who underwent surgical treatment. METHODS: This report is composed of a cohort of 36 elderly patients (older than 75 years) and 34 younger patients (younger than 65 years) who underwent decompressive surgery for CSM at one institution between 2001 and 2005. The patients' functional status was evaluated preoperatively and postoperatively using the mJOA disability scale. RESULTS: The mean follow-up time in the elderly group was 24 months, with a range from 12 to 48 months. There was a statistically significant improvement between mean preoperative (11.3) and postoperative (14.4) mJOA scores (P< .0001). The younger group had a higher neurologic recovery rate (71%) than the elderly group (59%); however, this was not statistically significant (P= .29). The postoperative complication rate in the elderly population (38%) was higher than in the younger group (6%; P= .002). CONCLUSION: Elderly patients with CSM are likely to obtain neurologic improvement after decompressive surgery. Their postoperative complication rate is higher than that of younger patients, yet most complications appear to be self limiting and do not adversely affect neurologic outcome.     

Measurement of outcome in patients with cervical spondylotic myelopathy treated surgically

The objective was to establish the role of the Short Form 36 (SF 36) as an objective measure of clinical outcome in cervical spondylotic myelopathy (CSM), and took the form of a prospective observational study. Seventy patients with symptomatic CSM were treated by surgical decompression. Health status was measured pre- and 3 months postoperation using objective, validated patient completed measures. These were the SF 36, neck disability index, myelopathy disability index and analogue scores for neck pain and arm symptoms. SF 36 scores were compared with age matched control data. Twelve-month postoperative data are available in a proportion of the cohort. CSM patients have lower preoperative SF 36 scores than age-matched population controls. Comparing pre- and postoperative SF36 scores for the physical functioning domain 64% of patients improve, 23% show no change and 14% of patients continue to deteriorate (Wilcoxon P< 0.0001). These changes are replicated in other domains of the SF36 and by the other measures of outcome. The SF36 is responsive, valid, and practical. Its use for determining outcome in the surgical treatment of CSM is recommended.     

Measurement of long-term outcome in patients with cervical spondylotic myelopathy treated surgically

Purpose

The Myelopathy Disability Index and the Neck Disability Index are widely used to assess outcome in cervical spine surgery. Short Form (SF) 36 is a generic measure of health which can be used to measure health gains across a wide variety of conditions. The aim of the current study is to assess long-term outcomes using these measures in a cohort of patients with cervical spondylotic myelopathy (CSM).

Methods

Cohort study with prospective data collection. Patients with CSM being offered decompressive surgery were asked to complete a set of generic and condition-specific outcome measures. This was repeated post-operatively at 3, 12, 24 and 60 months. SF-36 was used as a generic outcome measure and the Myelopathy Index, Neck Disability Score and visual analogue scores for arm, neck and hand pain, paraesthesia and dysthaesia were used as condition-specific outcome measures.

Results

Significant improvements in all outcome measures were seen in 70 % of the cohort. For SF-36, pre-operative scores were lower than age-matched controls in all domains and significant improvements were seen 3 months following surgery. This improvement in outcome was maintained at 5 years follow-up in approximately two-thirds of those with initial improvement.

Conclusion

We have used generic and condition-specific outcome measures of health and shown that in patients with CSM treated surgically, up to 70 % can expect improvement in their quality of life. These outcome measures are easy to collect and provide objective evidence of changes in quality of life and disability and can help quantify the potential health gains that can be achieved.     

Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery

This study investigated the posterior movement of the spinal cord after posterior decompression surgery and evaluated factors affecting postoperative functional recovery in patients with cervical spondylotic myelopathy (CSM). Thirty-two patients with CSM underwent posterior decompression from C3 to C7 through laminectomy (n=12) and single, open-door laminoplasty (n=20). There were no significant differences between laminectomy and laminoplasty in degree of spinal posterior movement, recovery rate, and curvature index. Japanese Orthopedic Association (JOA) scores improved from preoperative (10.63±1.77; range, 7-14) to 3-months postoperative (13.57±1.50; range, 11-16) (n=32, P<.05) and from preoperative (10.24±1.87; range, 7-14) to 6-months postoperative (14.16±1.54; range, 12-16) (n=21) (P<.05). C5 palsy was observed in 1 (3.1%) patient. The vertebral body-to-spinal cord distances significantly increased after operations, with the greatest posterior movement at C5 and the least posterior movement at C3 and C7. However, the difference in the degree of the spinal movement of C3 to C7 was not statistically significant (P>.05). Furthermore, no correlation was found between the magnitude of spinal posterior movement and the curvature index. In addition, the magnitude of posterior movement and age were not correlated with the postoperative JOA improvement, but the preoperative JOA scores were. Our study shows that both laminectomy and laminoplasty can produce a similar degree of posterior movement of the spinal cord. Cervical lordosis is not associated with the posterior movement of the cord. The preoperative JOA scores, but not posterior movement of the cord and age, are important determinants for postoperative outcome.     

坐骨神经阻滞和关节周围局部浸润麻醉对全膝关节置换术后镇痛效果的比较

目的比较坐骨神经阻滞和关节周围局部浸润麻醉对全膝关节置换手术术后镇痛效果的差异。方法采用前瞻性研究方法,33名符合条件的全膝关节手术患者,ASA分级Ⅰ或Ⅱ级,分为坐骨神经阻滞组(SNB组,16例,术毕给予0.375%罗哌卡因20 mL进行坐骨神经阻滞);局部浸润麻醉组(LIA组,17例,术毕给予0.2%的罗哌卡因150 mL加曲马多100 mg和0.5mg肾上腺素混合液行膝关节周围局部浸润麻醉)。于术后2 h、8 h、16 h、24 h、36 h、48 h评估静止状态下和活动状态下VAS评分分值的变化;观察术后恶心呕吐发生,局麻药中毒症状,皮疹发生,KSS评分在两组患者中的状况。结果 (1)与SNB组相比,术后2 h、8 h、16 h LIA组患者静止状态下的VAS评分偏高,差异有统计学意义(P0.01),但术后24 h、36 h和48 h LIA组患者的评分降低,差异有统计学意义(P0.01);(2)与SNB组相比,LIA组患者术后2 h、8 h运动状态下VAS评分偏高,差异有统计学意义(P0.01),LIA组患者在术后16 h、24 h、36 h和48 h的评分降低,差异有统计学意义(P0.01);(3)两组患者术后恶心呕吐发生,局麻药中毒症状,皮疹发生,KSS评分情况,差异无统计学意义。结论 SNB或者LIA都能为全膝关节手术提供良好的术后镇痛效果,但从操作便捷的角度来看,后者更适用于此类手术。     

改良单开门椎管扩大成形术治疗脊髓型颈椎病

目的探讨改良单开门椎管扩大成形术治疗脊髓型颈椎病的疗效。方法2005年3月至2006年5月,18例脊髓型颈椎病患者接受改良单开门椎管扩大成形术,即受压节段两端行部分椎板切除,中央行单开门椎管扩大成形术（A组）,23例患者接受传统C3-7,单开门椎板成形术,作为对照组（B组）,对两组患者手术前后的JOA评分改善率、减压程度、颈椎曲度指数、颈椎活动度及轴性症状严重程度进行随访,并比较评估。结果41例全部获得随访,JOA评分恢复率A组为（62．0±26．4）％,B组为（62．7±19．8）％,两组差异无统计学意义;两组病例术后MRI均显示椎管减压充分．患者术后颈椎曲度指数丢失A组为（2．75±2．68）％,B组为（5．23±2．02）％,两组比较差异有统计学意义（P〈0．01）;术后颈椎活动度丢失A组为（7．21±4．07）°,B组为（13．16±6．34）。,两组差异有统计学意义（P〈0．01）;术后有明显轴性症状者A组为22．2％．B组为56．5％．两组比较差异有统计学意义（P〈0．05）。结论改良椎管扩大成形术获得了良好的神经减压效果,与传统C3-7单开门椎板成形术相比,在对颈椎曲度指数、颈椎活动度的影响以及轴性症状发生率等方面有明显改善。     

Comparing the anatomic single-bundle versus the anatomic double-bundle for anterior cruciate ligament reconstruction: a prospective,randomized, single blind,clinical study

Purpose

The aim of this study was to compare the early results of anatomic single bundle versus double-bundle anterior cruciate ligament (ACL) reconstruction.

Methods

We conducted a prospective randomized study of anatomic single-bundle versus double-bundle ACL reconstruction using the hamstring tendons of 67 patients with unilateral ACL deficiency. The subjects were randomized into two groups. The single-bundle group consisted of 37 patients and the double-bundle group 30 patients. We used the following evaluations: clinical examination, KT-1000 arthrometry, Tegner knee score, modified Cincinnati score, Knee Injury and Osteoarthritis Outcome Scale (KOOS), International Knee Documentation Committee (IKDC) score. Two surgeons performed all operations, and a blinded independent author conducted the clinical follow-up assessments.

Results

The mean follow-up period was 25.8 months. The differences between the preoperative and postoperative clinical examinations and the KT-1000 measurements were statistically different in both groups (p?p?Conclusions This prospective study found no difference between the outcomes of the anatomic single-bundle and the anatomic double-bundle ACL reconstructions. Level of evidence II.     

前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病

目的　比较前路颈椎单椎体次全切除术中采用髂骨块植骨/Cage填充自体碎骨植骨治疗脊髓型颈椎病(CSM)的中期临床疗效。方法 2000年3月—2004年12月采用单椎体次全切除术并自体髂骨块植骨治疗CSM患者21例(A组),2013年1月—2015年12月采用颈椎前路单椎体次全切除术并Cage填充自体碎骨植骨治疗CSM患者32例(B组),对2组患者临床资料进行回顾性分析,对比颈椎整体曲度、融合节段角度、融合节段椎体间高度、融合率、沉降率及颈椎日本骨科学会(JOA)评分等指标。结果术后3 d及末次随访时2组颈椎整体曲度、融合节段角度及融合节段椎体间高度与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。A组1例发生植骨未融合,B组无植骨未融合发生。术后3个月及末次随访时2组JOA评分与术前相比均显著改善,差异有统计学意义(P 0.05),组间比较差异无统计学意义(P 0.05)。末次随访时B组沉降率(34.3%)高于A组(23.8%),差异有统计学意义(P 0.05)。2组末次随访时发生沉降者JOA评分与未发生沉降者相比,差异无统计学意义(P 0.05),并未影响远期临床疗效。结论前路颈椎单椎体次全切除术治疗CSM,与采用传统髂骨块植骨融合相比,术中采用Cage填充自体碎骨植骨可获得相近的影像学及临床疗效,Cage沉降并未显著影响远期疗效。     

两种前路手术治疗双节段脊髓型颈椎病的疗效比较

目的比较颈前路椎间盘切除减压融合术(ACDF)和颈前路椎体次全切减压融合术(ACCF)治疗双节段脊髓型颈椎病的临床疗效。方法将43例双节段脊髓型颈椎病患者按治疗方法分为两组,ACDF组23例,ACCF组20例。比较两组手术时间、术中出血量、住院时间、并发症发生率、术后JOA评分、植骨融合率和颈椎生理曲度改善情况。结果患者均获得随访,时间15~46个月。手术时间ACDF组为(106±23)min,ACCF组为(142±35)min;术中出血量ACDF组为(121±76)ml,ACCF组为(208±125)ml;两组两项比较差异均有统计学意义(P0.05)。两组住院时间、并发症发生率、植骨融合率比较差异无统计学意义(P0.05)。末次随访时JOA评分ACDF组从术前(10.32±1.47)分增加到(14.55±1.65)分,改善率62.82%±12.58%;ACCF组从术前(10.21±1.53)分增加到(14.39±1.76)分,改善率59.91%±13.28%;两组比较差异无统计学意义(P0.05)。术后颈椎生理曲度均得到明显改善,但ACDF组优于ACCF组,差异有统计学意义(P0.05)。结论 ACDF和ACCF治疗双节段脊髓型颈椎病均可取得满意的临床疗效,ACDF具有手术时间短、出血少、创伤小等优点。     

Bryan人工颈椎间盘置换与椎间融合治疗颈椎病疗效的对比研究

目的：分析对比Bryan人工颈椎间盘置换术与颈前路减压植骨融合术（ACDF）治疗颈椎病的疗效结果。方法：16例患者行Bryan人工颈椎间盘置换术（A组）,35例患者行ACDF（B组）,于术前、出院前、术后6周、3月、6月、12月、24月及随后每半年一次随访,通过JOA评分、生命质量SF-36评分、NDI评分评定治疗效果。同期摄X线片,检测病变节段的稳定性和活动度。结果：两组患者术中、术后均无严重并发症发生。所有患者均获得6年以上随访,平均73．5个月。A组术后无假体移位、脱落等并发症发生,有1例发生自发融合;置换节段活动度与置换前差异无显著性意义（P〉0．05）。B组术后6个月X线片示植骨全部达骨性融合。两组患者术后随访时临床症状均明显缓解,疗效满意。两组患者的JOA评分及SF-36评分、NDI评分术后随访时均较术前有明显提高（P〈0．05）。B组ROM较术前明显减小（P〈0．01）,A组手术前后的差异无统计学意义（侈O．05）;两组术后差异有统计学意义（P〈0．05）。结论：Bryan人工颈椎间盘置换术疗效良好,同时还保留颈椎病变节段活动度,减少轴性症状,为治疗颈椎病提供了一种新的方法。     

Effects of anterior contralateral cervical microdiskectomy on radiological and clinical outcome

BACKGROUND: We have conducted a prospective study to investigate the relationship between cervical spine alignment and clinical outcome in 102 patients undergoing anterior contralateral microdiskectomy without interbody graft or cage. METHODS: Preoperative and postoperative lateral cervical radiographs were obtained, and curvature of the surgically treated spinal segments and the overall curvature of the cervical spine were evaluated in all patients. Clinical outcomes were assessed using the NDI and SF-36. RESULTS: There was no significant change in the mean overall cervical curvature (C2-C7) angles postoperatively in late follow-up findings (P = .72). It represented a statistically significant mean loss of 2.73 degrees of segmental lordosis (P < .0001). The NDI scores decreased significantly in both early and late follow-up evaluations, and the SF-36 scores demonstrated significant improvement in late follow-up results in our series. Analysis of clinical outcome showed no statistical differences between patients with segmental lordosis or kyphosis. CONCLUSION: Despite the kyphosis seen at the treated levels, the overall alignment between C2 and C7 did not change significantly, indicating that the untreated segments of the cervical spine were compensating for focal kyphosis.     

Segmental anterior cervical corpectomy and fusion with preservation of middle vertebrae in the surgical management of 4-level cervical spondylotic myelopathy

Purpose

To compare perioperative parameters, clinical outcomes, radiographic parameters, and complication rates of segmental anterior cervical corpectomy and fusion (sACCF) plus preservation of middle vertebrae with those of cervical laminectomy plus fusion (CLF) in 67 patients with 4-level cervical spondylotic myelopathy (CSM).

Methods

Between July 2006 and May 2012, 67 consecutive patients [42 males and 25 females; mean age 57.8 years (range 34–77 years)] with 4-level CSM who underwent surgery and were followed for more than 1 year were enrolled in this study and divided into sACCF and CLF groups. The study compared perioperative parameters; surgery-related and instrumentation- and graft-related complication rates; clinical parameters; patient satisfaction; and radiologic parameters.

Results

Significant improvements were seen from preoperative to postoperative in both groups for all three measures of clinical outcome; between-group comparison revealed no significant difference for two of the three measures and significantly better scores for the CLF group in the third. Satisfaction was rated as excellent or good by 79.5 % of the sACCF group and 71.4 % of the CLF group, which was not a significant difference. Mean postoperative cervical lordosis was significantly greater in the sACCF group than in the CLF group. Blood loss and operative time were significantly greater in the CLF group than in the sACCF group and complication rate significantly lower for the sACCF group.

Conclusions

sACCF with preservation of middle vertebrae is a safe, reliable, and effective alternative procedure for the treatment of 4-level CSM.     

The influence of gender on postoperative PROMIS physical function outcomes following minimally invasive transforaminal lumbar interbody fusion

PurposeOur aim is to examine the gender performance of Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) scores among patients undergoing minimally invasive transforaminal lumbar fusion (MIS TLIF).MethodsA prospectively collected surgical dataset was retrospectively assessed for eligible patients from March 2015–June 2019. We included patients if they underwent primary MIS TLIF procedures on one or two vertebral levels. We collected baseline demographics, perioperative characteristics, and PROMIS-PF scores for each subject at pre and postoperative timepoints (e.g., 6-weeks, 3-months, 6-months, and 1-year). Chi-squared analyses were utilized to assess categorical variables and a Student’s t-tests analyzed continuous variables. A linear regression was used to analyze PROMIS-PF scores from baseline through all postoperative time points. Finally, we evaluated the PROMIS PF achievement of minimal clinically important difference (MCID) among gender.Results192 patients were included: 77 were females and 115 were males. No significant differences were observed among gender subgroups for PROMIS-PF scores at pre- or postoperative evaluations. Compared to males, females experienced significantly greater postoperative improvement with PROMIS-PF scores at the 3-month assessments, though no significant gender differences were observed during later follow-up evaluations at 6-months or one year. Females were observed to have significant PROMIS-PF score improvement from their preoperative evaluation to each postoperative score. Males were assessed to have statistically significant postoperative (e.g., at 3-months, 6-months, and 1-year) PROMIS-PF score improvement from their preoperative PROMIS-PF scores. There were no significant differences among gender in achieving MCID at any postoperative time interval.ConclusionAmong gender, we observed no statistically significant difference in PROMIS-PF scores during the pre- or postoperative evaluations. Additionally, with no difference in the rate of achieving PROMIS-PF MCID postoperatively, this study established that both genders should experience similar functional outcomes following MIS TLIF.     

Effect of subscapularis repair in patients with an intact rotator cuff undergoing reverse total shoulder arthroplasty

BackgroundReverse total shoulder arthroplasty (rTSA) is increasing in popularity worldwide. There remains considerable debate as to whether to repair subscapularis or not following the procedure. Previous research into all indications demonstrates similar outcomes regardless of subscapularis (SSC) repair when using a medial glenoid/lateral humeral implant. The purpose of this study is to assess the effects of SSC repair on postoperative shoulder function and patient reported outcomes scores only in patients with an intact rotator cuff undergoing rTSA.MethodsPatients who underwent a primary rTSA for osteoarthritis with a minimum of 2 years follow-up were identified from an international shoulder registry. Patients with rotator cuff tears, cuff arthropathy, or post-traumatic arthritis were excluded. They were then divided into age and gender matched groups based on whether they had SSC repaired or not; 436 patients were analyzed in total, with 218 in each group. Numerous outcome measures between groups were compared, including active shoulder range of motion, complication rates, and 7 different patient reported shoulder outcome scores, using MCID (Minimal Clinically Important Differences), SCB (Substantial clinical benefit), and a 2 tailed paired T-Test.ResultsIn both groups, improvement in average shoulder movement and patient reported shoulder scores exceeded the threshold of SCB with 93% reporting their symptoms were better or much better in both groups. Those who had SSC repaired demonstrated a statistically significantly better mean active forward flexion (144° vs. 138°, P= .021) and mean internal rotation score (4.8 vs. 4.0, P= <.05), however these differences did not exceed the MCID where available. With regard to patient reported scores, those who had SSC repaired demonstrated a statistically significantly better mean Constant score (71 vs. 68, P= .05) and Shoulder Arthroplasty Smart Score (78 vs. 75, P= <.05), however these differences did not exceed the MCID for either score (5.3 and 6.1 respectively). There was no difference in complication rates between groups, including dislocation.ConclusionThis study demonstrates excellent results following rTSA with a medial glenoid/lateral humeral implant design regardless of whether the SSC was repaired or not. For the majority of patient reported scores and shoulder movements there was no significant difference between SSC repaired and nonrepaired groups, and where statistically significant differences were noted, the difference did not exceed the MCID in any measure.Level of EvidenceLevel III; Retrospective Comparative Study     

Comparison of long-term quality of life after laparoscopic and open cholecystectomy

Background: Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation. Methods: This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome. Results: The mean administration time for the questionnaire was 46.8 ± 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 ± 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups. Conclusions: The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.     

p53-expression in patients with renal cell carcinoma correlates with a higher probability of disease progression and increased cancer-specific mortality after surgery but does not enhance the predictive accuracy of robust outcome models

Objective

Due to lacking external validation, molecular biomarkers are currently not applied for risk-stratification of patients with localized renal cell carcinoma. The objective of this study was to externally validate a molecular multi-marker panel included in a previously proposed prognostic nomogram for the prediction of postoperative disease-free survival.

MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病的治疗

目的分析比较MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者行手术治疗和非手术治疗的临床效果,初步探讨可能影响预后的相关因素。方法 2008年7月年-2011年6月,收治轻度脊髓型颈椎病患者91例符合纳入标准,进行回顾性研究,以日本骨科学会（Japanese Orthapaedic Association,JOA）评分改善率作为治疗后临床效果的评估指标,比较手术治疗和非手术治疗的情况。进一步将JOA评分改善率与治疗方式、性别、年龄、病程、节段性前凸角、C2-7活动度、脊髓受压程度进行相关及多元线性回归分析,筛选影响疗效的相关因素,并进一步明确其与治疗后临床效果的关系。结果根据治疗方法不同将本组病例分为2组,A组53例,采用颈前路减压植骨融合钢板内固定手术进行治疗,平均随访30.68个月。B组38例采用非手术治疗,平均随访34.68个月。对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,手术治疗与非手术治疗相比,两者临床疗效差异无统计学意义。病程（P〈0.01）、节段性前凸角（P〈0.01）2个因素与JOA评分改善率之间存在显著相关性。多元线性回归结果表明,病程较短、节段性前凸角较大的患者治疗后效果较好。结论对于MRI T2加权像伴有髓内高信号的轻度脊髓型颈椎病患者,其手术治疗和非手术治疗并无显著差异,然而病程较短、节段性前凸角较大的患者治疗的效果优于病程较长、节段后凸的患者。     

Mild diabetes is not a contraindication for surgical decompression in cervical spondylotic myelopathy: results of the AOSpine North America multicenter prospective study (CSM)

Background contextCervical spondylotic myelopathy (CSM) is a chronic spinal cord disease and can lead to progressive or stepwise neurologic decline. Several factors may influence this process, including extent of spinal cord compression, duration of symptoms, and medical comorbidities. Diabetes is a systemic disease that can impact multiple organ systems, including the central and peripheral nervous systems. There has been little information regarding the effect of diabetes on patients with coexistent CSM.PurposeTo provide empirical data regarding the effect of diabetes on treatment outcomes in patients who underwent surgical decompression for coexistent CSM.Study design/settingLarge prospective multicenter cohort study of patients with and without diabetes who underwent decompressive surgery for CSM.Patient sampleTwo hundred thirty-six patients without and 42 patients with diabetes were enrolled. Of these, 37 were mild cases and five were moderate cases. Four required insulin. There were no severe cases associated with end-organ damage.Outcome measuresSelf-report measures include Neck Disability Index and version 2 of 36-Item Short Form Health Survey (SF-36v2), and functional measures include modified Japanese Orthopedic Association (mJOA) score and Nurick grade.MethodsWe compared presurgery symptoms and treatment outcomes between patients with and without diabetes using univariate and multivariate models, adjusting for demographics and comorbidities.ResultsDiabetic patients were older, less likely to smoke, and more likely to be on social security disability insurance. Patients with diabetes presented with a worse Nurick grade, but there were no differences in mJOA and SF-36v2 at presentation. Overall, there was a significant improvement in all outcome parameters at 12 and 24 months. There was no difference in the level of improvement between the patients with and without diabetes, except in the SF-36v2 Physical Functioning, in which diabetic patients experienced significantly less improvement. There were no differences in surgical complication rates between diabetic patients and nondiabetic patients.ConclusionsExcept for a worse Nurick grade, diabetes does not seem to affect severity of symptoms at presentation for surgery. More importantly, with the exception of the SF-36v2 Physical Functioning scores, outcomes of surgical treatment are similar in patients with diabetes and without diabetes. Surgical decompression is effective and should be offered to patients with diabetes who have symptomatic CSM and are appropriate surgical candidates.     

Clinical features and surgical outcomes of cervical spondylotic myelopathy in patients aged 80?years or older: a multi-center retrospective study

With the aging of the population in developed countries, spine surgeons have recently been more likely to encounter elderly patients in need of treatment. This study investigated whether decompression surgery for cervical spondylotic myelopathy (CSM) in elderly patients aged 80 years or older would likely be a reasonable treatment. We retrospectively reviewed 605 consecutive patients with cervical myelopathy who underwent decompression surgery between 2004 and 2008. Patients with other conditions that could affect functional status or compression factors other than spondylosis were excluded from this study. Of the remaining 189 patients, 161 with CSM whose condition could be evaluated 6 months after surgery were analyzed. The patients were divided into two age groups: 80 years or older (Group A, 37 patients) and younger than 80 years of age (Group B, 124 patients). We evaluated the differences in symptom duration, clinical data, involved levels, surgical outcome, comorbidities, and postoperative complications between the two groups. The symptom duration was significantly shorter in Group A. The average JOA scores preoperatively and 6 months postoperatively were significantly lower in Group A; however, there was no significant difference in the recovery ratio. There were no significant differences in the percentages of patients with comorbidities or those with postoperative complications. Elderly patients aged 80 years or older regained approximately 40% of their function postoperatively, and the incidence of postoperative complication was similar to that in younger patients. Since this age group shows a rapid deterioration after onset, prompt decompression surgery is required.