Postoperative Complications of Surgery for Cervical Spondylotic Myelopathy with and Without Athetoid Cerebral Palsy

Naohiro Tachibana; Nobuaki Michihata; Takeshi Oichi; Kosei Nagata; Hideki Nakamoto; Nozomu Ohtomo; Yuichi Yoshida; Koji Nakajima; Junya Miyahara; So Kato; Toru Doi; Yuki Taniguchi; Yoshitaka Matsubayashi; Sakae Tanaka; Hideo Yasunaga; Yasushi Oshima

doi:10.1177/21925682241239610

Postoperative Complications of Surgery for Cervical Spondylotic Myelopathy with and Without Athetoid Cerebral Palsy

Global Spine J. 2024 Mar 11:21925682241239610. doi: 10.1177/21925682241239610. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Japan.
² Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.

Abstract

Study design: Retrospective cohort study.

Objectives: With the aging of the Japanese population, patients with athetoid cerebral palsy (ACP) are getting older, and the rate of surgery for CSM is increasing in ACP patients. However, postoperative complications of such surgery among adult patients with ACP have not been reported yet. We investigated postoperative complications of surgery for CSM with ACP and compared them with those of surgery for CSM without ACP using a national inpatient database of Japan.

Methods: Using the Diagnosis Procedure Combination database, we identified 61382 patients who underwent surgery for CSM from July 2010 to March 2018. We examined patient backgrounds, surgical procedures, and type of hospital, and a 4:1 propensity score matching was performed to compare the outcomes between the non-ACP and ACP groups.

Results: There were 60 847 patients without ACP and 535 patients with ACP. The mean age was 68.5 years in the non-ACP group and 55 years in the ACP group. The percentages of patients who underwent fusion surgery were 21.6% and 68.8% in the non-ACP and ACP groups, respectively. The 4:1 propensity score matching selected 1858 in the non-ACP group and 465 in the ACP group. The ACP group was more likely to have postoperative urinary tract infection (.4% vs 2.8%, P < .001), postoperative pneumonia (.4% vs 2.4%, P < .001), and 90-day readmission for reoperation (1.9% vs 4.3%, P = .003).

Conclusions: We found that ACP patients were more vulnerable to postoperative complications and reoperation after CSM than non-ACP patients.

Keywords: athetoid cerebral palsy; cardiovascular events; cervical spondylotic myelopathy; in-hospital mortality; pneumonia; postoperative complications; propensity score analysis; reoperation.