Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathy Article Swipe
Nathaniel Toop
,
Connor S. Gifford
,
Ben G. McGahan
,
David Gibbs
,
Shelby D. Miracle
,
Jan M. Schwab
,
Rouzbeh Motiei-Langroudi
,
H. Francis Farhadi
·
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.3171/2022.6.spine2234
YOU?
·
· 2022
· Open Access
·
· DOI: https://doi.org/10.3171/2022.6.spine2234
OBJECTIVE Degenerative cervical myelopathy (DCM) is routinely treated with surgical decompression, but disparate postoperative outcomes are frequently observed, ranging from complete neurological recovery to persistent decline. Although numerous clinical and radiological factors have been independently associated with failure to improve, the relative impact of these proposed risk factors remains obscure. In this study, the authors assess the combined role of clinical and radiographic parameters in contributing to failure to attain neurological improvement after surgery. METHODS A consecutive series of patients who underwent surgery for DCM between July 2013 and August 2018 at a single institution was identified from a prospectively maintained database. Retrospective chart review was undertaken to record perioperative clinical and radiographic parameters. Failure to improve on the last follow-up evaluation after surgery, defined as a change in modified Japanese Orthopaedic Association (mJOA) score less than 2, was the primary outcome in univariate and multivariate analyses. RESULTS The authors included 183 patients in the final cohort. In total, 109 (59.6%) patients improved (i.e., responders with ΔmJOA score ≥ 2) after surgery and 74 (40.4%) were nonresponders with ΔmJOA score < 2. Baseline demographic variables and comorbidity rates were similar, whereas baseline Nurick score was the only clinical variable that differed between responders and nonresponders (2.7 vs 3.0, p = 0.02). In contrast, several preoperative radiographic variables differed between the groups, including presence and degree of cervical kyphosis, number of levels with bidirectional cord compression, presence and number of levels with T2-weighted signal change, intramedullary lesion (IML) length, Torg ratio, and both narrowest spinal canal and cord diameter. On multivariate analysis, preoperative degree of kyphosis at C2–7 (OR 1.19, p = 0.004), number of levels with bidirectional compression (OR 1.83, p = 0.003), and IML length (OR 1.14, p < 0.001) demonstrated the highest predictive power for nonresponse (area under the receiver operating characteristic curve 0.818). A risk factor point system that predicted failure of improvement was derived by incorporating these 3 variables. CONCLUSIONS When a large spectrum of both clinical and radiographic variables is considered, the degree of cervical kyphosis, number of levels with bidirectional compression, and IML length are the most predictive of nonresponse after surgery for DCM. Assessment of these radiographic factors can help guide surgical decision-making and more appropriately stratify patients in clinical trials.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.3171/2022.6.spine2234
- https://thejns.org/downloadpdf/journals/j-neurosurg-spine/38/1/article-p14.pdf
- OA Status
- bronze
- Cited By
- 5
- References
- 47
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4292375787
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Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4292375787Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.3171/2022.6.spine2234Digital Object Identifier
- Title
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Influence of clinical and radiological parameters on the likelihood of neurological improvement after surgery for degenerative cervical myelopathyWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2022Year of publication
- Publication date
-
2022-08-19Full publication date if available
- Authors
-
Nathaniel Toop, Connor S. Gifford, Ben G. McGahan, David Gibbs, Shelby D. Miracle, Jan M. Schwab, Rouzbeh Motiei-Langroudi, H. Francis FarhadiList of authors in order
- Landing page
-
https://doi.org/10.3171/2022.6.spine2234Publisher landing page
- PDF URL
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https://thejns.org/downloadpdf/journals/j-neurosurg-spine/38/1/article-p14.pdfDirect link to full text PDF
- Open access
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YesWhether a free full text is available
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bronzeOpen access status per OpenAlex
- OA URL
-
https://thejns.org/downloadpdf/journals/j-neurosurg-spine/38/1/article-p14.pdfDirect OA link when available
- Concepts
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Medicine, Myelopathy, Surgery, Radiography, Retrospective cohort study, Perioperative, Intramedullary rod, Cohort, Internal medicine, Spinal cord, PsychiatryTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
5Total citation count in OpenAlex
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2025: 4, 2023: 1Per-year citation counts (last 5 years)
- References (count)
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47Number of works referenced by this work
- Related works (count)
-
10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.clinical | 28, 60, 110, 197, 330, 376 |
| abstract_inverted_index.combined | 57 |
| abstract_inverted_index.complete | 20 |
| abstract_inverted_index.decline. | 25 |
| abstract_inverted_index.differed | 200, 217 |
| abstract_inverted_index.improve, | 39 |
| abstract_inverted_index.improved | 162 |
| abstract_inverted_index.included | 150 |
| abstract_inverted_index.kyphosis | 264 |
| abstract_inverted_index.modified | 129 |
| abstract_inverted_index.numerous | 27 |
| abstract_inverted_index.obscure. | 49 |
| abstract_inverted_index.outcomes | 14 |
| abstract_inverted_index.patients | 79, 152, 161, 374 |
| abstract_inverted_index.presence | 222, 235 |
| abstract_inverted_index.proposed | 45 |
| abstract_inverted_index.receiver | 301 |
| abstract_inverted_index.recovery | 22 |
| abstract_inverted_index.relative | 41 |
| abstract_inverted_index.similar, | 189 |
| abstract_inverted_index.spectrum | 327 |
| abstract_inverted_index.stratify | 373 |
| abstract_inverted_index.surgery, | 123 |
| abstract_inverted_index.surgery. | 73 |
| abstract_inverted_index.surgical | 9, 368 |
| abstract_inverted_index.variable | 198 |
| abstract_inverted_index.OBJECTIVE | 0 |
| abstract_inverted_index.analyses. | 146 |
| abstract_inverted_index.analysis, | 260 |
| abstract_inverted_index.contrast, | 212 |
| abstract_inverted_index.database. | 101 |
| abstract_inverted_index.diameter. | 257 |
| abstract_inverted_index.disparate | 12 |
| abstract_inverted_index.follow-up | 120 |
| abstract_inverted_index.including | 221 |
| abstract_inverted_index.kyphosis, | 227, 340 |
| abstract_inverted_index.narrowest | 252 |
| abstract_inverted_index.observed, | 17 |
| abstract_inverted_index.operating | 302 |
| abstract_inverted_index.predicted | 312 |
| abstract_inverted_index.routinely | 6 |
| abstract_inverted_index.underwent | 81 |
| abstract_inverted_index.variables | 184, 216, 333 |
| abstract_inverted_index.Assessment | 360 |
| abstract_inverted_index.associated | 35 |
| abstract_inverted_index.evaluation | 121 |
| abstract_inverted_index.frequently | 16 |
| abstract_inverted_index.identified | 96 |
| abstract_inverted_index.maintained | 100 |
| abstract_inverted_index.myelopathy | 3 |
| abstract_inverted_index.parameters | 63 |
| abstract_inverted_index.persistent | 24 |
| abstract_inverted_index.predictive | 294, 353 |
| abstract_inverted_index.responders | 164, 202 |
| abstract_inverted_index.undertaken | 106 |
| abstract_inverted_index.univariate | 143 |
| abstract_inverted_index.variables. | 322 |
| abstract_inverted_index.Association | 132 |
| abstract_inverted_index.CONCLUSIONS | 323 |
| abstract_inverted_index.Orthopaedic | 131 |
| abstract_inverted_index.T2-weighted | 241 |
| abstract_inverted_index.comorbidity | 186 |
| abstract_inverted_index.compression | 277 |
| abstract_inverted_index.consecutive | 76 |
| abstract_inverted_index.considered, | 335 |
| abstract_inverted_index.demographic | 183 |
| abstract_inverted_index.improvement | 71, 315 |
| abstract_inverted_index.institution | 94 |
| abstract_inverted_index.nonresponse | 297, 355 |
| abstract_inverted_index.parameters. | 113 |
| abstract_inverted_index.Degenerative | 1 |
| abstract_inverted_index.compression, | 234, 346 |
| abstract_inverted_index.contributing | 65 |
| abstract_inverted_index.demonstrated | 291 |
| abstract_inverted_index.multivariate | 145, 259 |
| abstract_inverted_index.neurological | 21, 70 |
| abstract_inverted_index.preoperative | 214, 261 |
| abstract_inverted_index.radiographic | 62, 112, 215, 332, 363 |
| abstract_inverted_index.radiological | 30 |
| abstract_inverted_index.Retrospective | 102 |
| abstract_inverted_index.appropriately | 372 |
| abstract_inverted_index.bidirectional | 232, 276, 345 |
| abstract_inverted_index.incorporating | 319 |
| abstract_inverted_index.independently | 34 |
| abstract_inverted_index.nonresponders | 176, 204 |
| abstract_inverted_index.perioperative | 109 |
| abstract_inverted_index.postoperative | 13 |
| abstract_inverted_index.prospectively | 99 |
| abstract_inverted_index.characteristic | 303 |
| abstract_inverted_index.decompression, | 10 |
| abstract_inverted_index.intramedullary | 244 |
| abstract_inverted_index.decision-making | 369 |
| cited_by_percentile_year.max | 98 |
| cited_by_percentile_year.min | 89 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 8 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.6499999761581421 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.77622676 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |