Effect of Psychiatric Comorbidities on In-Hospital Outcomes and Cost for Cervical Spondylotic Myelopathy

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Objective

To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy.

Methods

Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy.

Results

No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery (p < 0.05), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up (p > 0.05). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up (p < 0.05). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group (p < 0.05), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group (p < 0.05).

Conclusion

This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.

Correlating Psychological Comorbidities and Outcomes After Spine Surgery

STUDY DESIGN

Literature review.

OBJECTIVE

The aim of this literature review is to examine the effects of psychological disorders on postoperative complications, surgical outcomes, and long-term narcotic use. We also hope to detail the value of preoperative identification and treatment of these pathologies.

METHODS

A series of systematic reviews of the relevant literature examining the effects of psychological disorders and spine surgery was conducted using PubMed and Cochrane databases.

RESULTS

Combined, the database queries yielded 2275 articles for consideration. After applying screening criteria, 96 articles were selected for inclusion. Patients with underlying psychological disease have higher rates of delirium, readmission, longer hospital stays, and higher rates of nonroutine discharge following spine surgery. They also have higher rates of chronic postoperative narcotic use and may experience worse surgical outcomes. Because of these defined issues, researchers have developed multiple screening tools to help identify patients with psychological disorders preoperatively for potential treatment. Treatment of these disorders prior to surgery may significantly improve surgical outcomes.

CONCLUSION

Patients with psychological disorders represent a unique population with respect to their higher rates of spinal pain complaints, postoperative complications, and worsened functional outcomes. However, proper identification and treatment of these conditions prior to surgery may significantly improve many outcome measures in this population. Future investigations in this field should attempt to develop and validate current strategies to identify and treat individuals with psychological disorders before surgery to further improve outcomes.