Cervical spondylotic myelopathy patients with prior cerebral infarction: Clinical characteristics, surgical outcomes and prognostic value of “prior cerebral infarction”

• Published in: Clinical neurology and neurosurgery Vol. 175; pp. 34 - 39
• Main Authors: Wang, Yu, Wang, Wangfei, Zhu, Minyu, Wang, Jing, Zhou, Yang, Huang, Kelun, Wang, Jianhong, Teng, Honglin
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2018; Elsevier Limited
• Subjects: Age; Central nervous system diseases; Cerebral infarction; Cervical spondylotic myelopathy; Clinical characteristic; Demographics; Diabetes; Gait; Gender; Hypertension; Ischemia; Magnetic resonance imaging; Multivariate analysis; Neurological complications; Neurology; NMR; Nuclear magnetic resonance; Patients; Predictor; Regression analysis; Risk factors; Smoking; Spinal cord; Statistical analysis; Surgery; Surgical outcome; Surgical outcomes; Variables; Cerebral infarction; Clinical characteristic; Predictor; Cervical spondylotic myelopathy; Surgical outcome
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2018.09.034

•Cervical myelopathy patients with prior cerebral infarction (CI) were studied.•Rapid progressive and advanced myelopathy is common in these patients.•“Intramedullary T2-weighted hyperintensity” is common in these patients.•CI may directly trigger progression of cervical myelopathy.•“Prior CI” correlates with poor surgical outcomes of cervical myelopathy. To investigate the clinical characteristics and surgical outcomes of patients with cervical spondylotic myelopathy (CSM) and prior cerebral infarction (CI); to identify whether “prior CI” correlates with poor surgical outcomes. Twenty-two patients with CSM and prior CI were retrospectively reviewed and included as the CI group while 100 CSM patients without CI were included as the control group (matched for gender, age, symptom duration and surgical approach). Extensive demographic and surgery-related data for patients in both groups were collected and compared. Multivariate logistic regression analysis was performed to assess all potential factors affecting surgical outcomes. Compared to the control group, the CI group had the following: significantly higher percentages of hypertension, “progressive myelopathy”, “rapid progressive myelopathy” and “intramedullary T2-weighted hyperintensity on MRI”; lower mean “preoperative mJOA score” and “postoperative mJOA score”; higher percentages of “preoperative mJOA score ≤11″ and “recovery rate of mJOA score <50%”. In the CI group, 14 patients had CI within 6 months before CSM, and their percentage of “rapid progressive myelopathy” was higher than that of patients who had CI over 6 months before CSM. Logistic regression analysis showed that smoking, “symptom duration ≥12 months”, “T2-weighted hyperintensity” and “prior CI” correlated with poor surgical outcome. Rapid progressive myelopathy with advanced neurological impairment and “intramedullary T2-weighted hyperintensity” are common in patients with CSM and prior CI. Surgical outcomes in these patients are poorer than those of ordinary CSM patients. “Prior CI” is a risk factor for predicting poor surgical outcomes.