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Citation
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Kimura A, Seichi A, Takeshita K, Inoue H, Kato T, Yoshii T, Furuya T, Koda M, Takeuchi K, Matsunaga S, Seki S, Ishikawa Y, Imagama S, Yamazaki M, Mori K, Kawasaki Y, Fujita K, Endo K, Sato K, Okawa A. Spine 2016; 42(7): E398-E403. |
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Affiliation
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*Department of Orthopaedics, Jichi Medical University †Department of Orthopedic Surgery, Mitsui Memorial Hospital ‡Department of Orthopedic Surgery, Tokyo Medical and Dental University §Department of Orthopedic Surgery, Chiba University Graduate School of Medicine ¶Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center ||Department of Orthopedic Surgery, Imakiire General Hospital **Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama ††Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine ‡‡Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba §§Department of Orthopedic Surgery, Shiga University of Medical Science ¶¶Department of Orthopedic Surgery, University of Yamanashi ||||Department of Orthopaedic Surgery, Tokyo Medical University ***Department of Orthopaedic Surgery, Kurume University School of Medicine. |
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Abstract
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STUDY DESIGN: Retrospective multi-center study.
OBJECTIVE: This study was conducted in order to clarify the incidence and neurological outcomes of fall-related deterioration of subjective symptoms in patients undergoing surgical treatment. SUMMARY OF BACKGROUND DATA: The evidence that minor trauma, including falls, increases the risk of worsening cervical myelopathy is insufficient.
METHODS: A retrospective analysis of patients who had undergone surgery for cervical myelopathy at 12 participating institutes was conducted. Patients who had undergone surgery for symptomatic cervical myelopathy from January 2012 to December 2013 and completed at least 1-year follow-up were included in this study. Data were collected by chart review and a questionnaire that included numbers of recalled falls during the last preoperative year and first postoperative year, circumstances of falls, and whether the patient had experienced fall-related deterioration of subjective symptoms.
RESULTS: A total of 360 eligible patients were recruited into the study. Of these, 177 (49%) reported at least one fall during the last preoperative year, and 105 (29%) experienced fall-related deterioration of subjective symptoms. Forty (11%) reported deterioration of numbness in the arms or legs, and 65 (18%) reported deterioration of motor deficits. Incidences of falls and fall-related deterioration of symptoms decreased significantly after surgery. Patients who experienced fall-related deterioration of motor deficits showed significantly worse surgical outcomes as assessed by Japanese Orthopaedic Association (JOA) score compared with those who did not experience deterioration. The optimal cut-off for preoperative JOA score in predicting an increased risk of fall-related deterioration in motor deficits was 8.
CONCLUSION: Patients with cervical myelopathy commonly experienced preoperative fall-related deterioration of subjective symptoms, associated with significantly worse neurological outcomes. Surgical treatment significantly reduced the incidence of both falls and fall-related deterioration of subjective symptoms. LEVEL OF EVIDENCE: 4.
Language: en |