| Objective To investigate the risk factors of rapidly progressing cervical spondylotic myelopathy (rp-CSM) and the efficacy of anterior cervical surgery. Methods A retrospective analysis was conducted on 98 patients with CSM admitted to our hospital from September 2011 to September 2021. They were divided into the rp-CSM group and the chronic CSM (c-CSM) group based on the deterioration time and severity of preoperative neurological dysfunction. All patients underwent anterior surgery and were followed up for 18 months. Univariate analysis was used to assess the general information of two groups of patients, including gender, age, course of disease, body mass index (BMI), underlying disease, congenital spinal stenosis, and intramedullary high-signal intensity of T2-weighted images. The American Spinal Injury Association (ASIA) spinal cord injury grading, the Japanese Orthopedic Association (JOA) score, and the improvement rate of JOA were used to evaluate the neurological function, and the incorporate differentiated indicators were included in the multivariate logistic regression analysis to evaluate the risk factors of rp-CSM. Results Among 98 patients, 32 (32.7%) were diagnosed with rp-CSM. Univariate analysis showed that there was a statistically significant difference between the two groups in the course of disease, diabetes, congenital spinal stenosis, and intramedullary high-signal intensity of T2-weighted images (P＜0.05). Multivariate Logistic regression analysis showed that the history of diabetes (OR=4.340, 95% CI: 1.462-12.883, P=0.008), congenital spinal stenosis (OR=5.714, 95% CI: 1.455-22.442, P=0.013), and intramedullary high-signal intensity of T2-weighted images (OR=3.390, 95% CI: 1.019-11.278, P=0.047) were the risk factors for the occurrence of rp-CSM. At 18 months after surgery, there was no statistically significant difference in the ASIA grading and JOA scores between the two groups (P＞0.05). The improvement rate of JOA in the rp-CSM group was significantly higher than that in the c-CSM group (68.70%±10.87% vs. 41.61%±20.02%), and the rp-CSM group showed good neurological recovery efficiency after anterior cervical decompression surgery. Conclusion Diabetes, intramedullary high-signal intensity of T2-weighted images and congenital spinal stenosis are independent risk factors of rp-CSM, and rp-CSM is a reversible disease that can achieve good neurological recovery through early decompression surgery. |
