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Operative fusion of multilevel cervical spondylotic myelopathy: Impact of patient demographics.

Operative fusion of multilevel cervical spondylotic myelopathy: Impact of patient demographics.

Authors :
McClelland S 3rd
Marascalchi BJ
Passias PG
Protopsaltis TS
Frempong-Boadu AK
Errico TJ
Source :
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia [J Clin Neurosci] 2017 May; Vol. 39, pp. 133-136. Date of Electronic Publication: 2017 Jan 10.
Publication Year :
2017

Abstract

Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in patients older than age 55, with operative management being a widely adopted approach. Previous work has shown that private insurance status, gender and patient race are predictive of the operative approach patients receive (anterior-only, posterior-only, combined anterior-posterior). The Nationwide Inpatient Sample from 2001 to 2010 was used to assess the potential role of multilevel CSM as a contributing factor in determining which operative approach CSM patients receive, as it is rare for an anterior-only approach to be sufficient for CSM patients requiring fusion of four or more involved levels. Multivariate analyses revealed that female sex (OR=3.78; 95% CI=2.08-6.89; p<0.0001), private insurance (OR=5.02; 95% CI=2.26-11.12; p<0.0001), and elective admission type (OR=4.12; 95% CI=1.65-10.32; p=0.0025) were predictive of increased receipt of a 3+ level fusion in CSM. No other variables, including patient age, race, income, or admission source were predictive of either increased or decreased likelihood of receiving fusion of at least three levels for CSM. In conclusion, female sex, private insurance status, and elective admission type are each independent predictors in CSM for receipt of a 3+ level fusion, while patient age, race and income are not. Given the propensity of fusions greater than three levels to require posterior approaches and the association between posterior CSM approaches and increased morbidity/mortality, these findings may prove useful as to which patient demographics are predictive of increased morbidity and mortality in operative treatment of CSM.<br /> (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Details

Language :
English
ISSN :
1532-2653
Volume :
39
Database :
MEDLINE
Journal :
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
Publication Type :
Academic Journal
Accession number :
28087188
Full Text :
https://doi.org/10.1016/j.jocn.2016.12.027