Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score
Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognost...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2016-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=2;spage=82;epage=86;aulast=Aggarwal |
| _version_ | 1818151700513423360 |
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| author | Rishi Anil Aggarwal Sudhir Kumar Srivastava Sunil Krishna Bhosale Pradip Sharad Nemade |
| author_facet | Rishi Anil Aggarwal Sudhir Kumar Srivastava Sunil Krishna Bhosale Pradip Sharad Nemade |
| author_sort | Rishi Anil Aggarwal |
| collection | DOAJ |
| description | Context: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as "good" if the patient had mJOA score ≥16 and "poor" if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM. |
| first_indexed | 2024-12-11T13:43:00Z |
| format | Article |
| id | doaj.art-00958abaeb0f4af3a963a7cafe130653 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-11T13:43:00Z |
| publishDate | 2016-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-00958abaeb0f4af3a963a7cafe1306532022-12-22T01:04:41ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372016-01-0172828610.4103/0974-8237.181828Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic scoreRishi Anil AggarwalSudhir Kumar SrivastavaSunil Krishna BhosalePradip Sharad NemadeContext: Preoperative severity of myelopathy, age, and duration of symptoms have been shown to be highly predictive of the outcome in compressive cervical myelopathy (CCM). The role of radiological parameters is still controversial. Aims: Define the prognostic factors in CCM and formulate a prognostic score to predict the outcome following surgery in CCM. Settings and Design: Retrospective. Materials and Methods: This study included 78 consecutive patients with CCM treated surgically. The modified Japanese Orthopaedic Association (mJOA) scale was used to quantify severity of myelopathy at admission and at 12-month follow-up. The outcome was defined as "good" if the patient had mJOA score ≥16 and "poor" if the score was <16. Age, sex, duration of symptoms, comorbidities, intrinsic hand muscle wasting (IHMW), diagnosis, surgical technique, Torg ratio, instability on dynamic radiographs, and magnetic resonance imaging (MRI) signal intensity changes were assessed. Statistics: Statistical Package for the Social Sciences (SPSS) (version 20.0) was used for statistical analysis. The association was assessed amongst variables using logistic regression analysis. Parameters having a statistically significant correlation with the outcome were included in formulating a prognostic score. Results: Severity of myelopathy, IHMW, age, duration, diabetes, and instability on radiographs were predictive of the outcome with a P value <0.01. Genders, diagnosis, surgical procedure, Torg ratio, and intensity changes on MRI were not significantly related to the outcome. A 8-point scoring system was devised incorporating the significant clinicoradiological parameters, and it was found that nearly all patients (97.82%) with a score below 5 had good outcome and all patients (100%) with a score above 5 had poor outcome. The outcome is difficult to predict with a score of 5. Conclusions: Clinical parameters are better predictors of the outcome as compared to radiological findings, following surgery in CCM. A simple scoring system based on clinicoradiological parameters is suggested in this paper to predict the outcome following surgery in cases of CCM.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=2;spage=82;epage=86;aulast=AggarwalCompressive cervical myelopathy (CCM)predictors of the outcomescoresurgical outcome |
| spellingShingle | Rishi Anil Aggarwal Sudhir Kumar Srivastava Sunil Krishna Bhosale Pradip Sharad Nemade Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score Journal of Craniovertebral Junction and Spine Compressive cervical myelopathy (CCM) predictors of the outcome score surgical outcome |
| title | Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score |
| title_full | Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score |
| title_fullStr | Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score |
| title_full_unstemmed | Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score |
| title_short | Prediction of surgical outcome in compressive cervical myelopathy: A novel clinicoradiological prognostic score |
| title_sort | prediction of surgical outcome in compressive cervical myelopathy a novel clinicoradiological prognostic score |
| topic | Compressive cervical myelopathy (CCM) predictors of the outcome score surgical outcome |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2016;volume=7;issue=2;spage=82;epage=86;aulast=Aggarwal |
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