Significant Predictors of Functional Status and Complications in Patients Ungergoing Surgery for the Treatment of Cervical Spondylotic Myelopathy

Introduction: Cervical spondylotic myelopathy (CSM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. Surgery is increasingly recommended as the preferred management strategy for these patients as it can effectively halt neurological progression and improve functional status. In this field, there is an increasing need to manage patients’ expectations of outcomes and inform them of relative risks and benefits of their surgical procedure. Objectives: This thesis aims to identify important predictors of functional outcomes and perioperative complications in patients undergoing surgery for the treatment of CSM. Methods: Three systematic reviews of the literature were performed to identify 1) important clinical predictors of surgical outcome; 2) important imaging predictors of surgical outcome; and 3) significant clinical and surgical predictors of complications. Two surveys were also conducted to evaluate what spine professionals believed were the most critical predictors of functional outcomes and complications. Finally, using prospectively-collected data, we developed a clinical and a complications prediction rule to predict functional status at 1-year follow-up and a patient’s risk of complications. Results: Patients were more likely to achieve an “optimal outcome” if they were younger; had milder myelopathy and a shorter duration of symptoms preoperatively; did not smoke; had fewer and less severe co-morbidities; and did not present with gait dysfunction. Patients were at a higher risk of perioperative complications if they had a greater number of co-morbidities, co-existing diabetes, a diagnosis of myelopathy secondary to ossification of a posterior longitudinal ligament and a longer operative duration. Conclusions: Our outcomes prediction study provides information that can be used by clinicians to manage patients’ expectations and counsel concerned patients as to potential treatment options. Furthermore, the results from this study emphasize the importance of accurately detecting CSM at a mild disease state and referring these patients for early surgical consultation. The knowledge gained from our complications study can be used by surgeons to objectively quantify a patient’s risk of complications and discuss this risk during the surgical consent process. Furthermore, surgeons should use this information to institute case-specific preventative plans and to strategize appropriate postoperative care.Ph.D