Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. However, it is difficult to preoperatively predict the extent to which patients will experience postoperative neurological improvement. We aimed to identify predictors associated with neurological recovery after ADF in a retrospective study of prospectively collected data.
We prospectively enrolled patients who were scheduled for ADF for DCM. The associations of baseline variables with recovery rate were investigated using a multiple linear regression model.
In total, 36 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life Five Dimensions Scale, Neck Disability Index, and Physical Component Summary of the SF-36 (PCS) scores improved postoperatively. The recovery rate was significantly correlated with the sagittal vertical axis (SVA) and T1 pelvic angle. Univariate regression analyses showed that the SVA and PCS score were significantly associated with recovery rate. Lastly, multiple regression analysis identified the independent predictors of recovery rate after ADF as thoracic kyphosis (TK), PCS, and SVA. According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS).
Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, DCM patients with these predictors who undergo ADF might be cautioned about poor recovery and be required to provide adequate informed consent.