Correlative Study On Risk Factors Of Rapid Progressive Spinal Cervical Spondylosis

Objective: The purpose of this study was to clarify the risk factors and evaluate the clinical efficacy of patients with rapidly progressive cervical Spondylotic myelopathy(rp-CSM).Methods:Summary of background data.Cervical Spondylotic myelopathy is a degenerative spinal disease characterized by the slow development of myelopathy.However,some patients showed rapid progressive neurodegeneration(especially gait disorders)without any trauma.At present,there is little information about this situation.Method.A total of 98 patients with myelopathy treated in the Department of Spinal surgery of the third Hospital of Hebei Medical University from June 2017 to October 2018 were analyzed retrospectively.Due to various factors,27 patients were excluded.Finally,71 patients(52 males and 19 females)were included in this study,with an average age of 67.1 years and a follow-up period of 1 year.The patients were divided into two groups: rapid progression group(rp-CSM)and chronic progression group(c-CSM).The basic clinical data of the patients included(JOA)score of Japanese Orthopaedic Association,age,sex,basic disease,waiting time from onset of symptoms to operation,range of motion of cervical vertebra and T2 high signal intensity of intramedullary magnetic resonance imaging.Logistic regression was used to analyze the multivariate effects of clinical prognosis and to determine independent risk factors.Results:Of the 71 patients,18(25.4%)were diagnosed as rapidly progressive cervical Spondylotic myelopathy and were included in the rp-CSM group and 53 cases in the c-CSM group.There was no significant difference in age,sex and range of neck motion between the two groups.The function of upper limb / lower limb and bladder was poor and the waiting time for operation was shorter in rp-CSM group(1.20.8 months in rp-CSM group and 25.7 ±35.3months in c-CSM group).In univariate analysis,patients with a history of cardiovascular events(rp-CSM44.4%,c-CSM15.1% P=0.019)and intramed-ullary magnetic resonance T2 high signal intensity(rp-CSM 94.4% rp-CSM CSM 88.5% P=0.004),especially at the level of C4 pedicle 5 intervertebral disc,showed statistical differences.Through multivariate logistic regression analysis,CVE history(odds ratio [OR] 4.7)95% confidence interval 1.3 OR 17.5(P= 0.021)and high MRI T2 intensity(OR 12.5)95% confidence interval 1.5 106.0(P= 0.020)were highly correlated with clinical efficacy.All patients had a good recovery of neurological function after operation(JOA score recovery rate: rp-CSM 64.5% maxim CSM 40.7%).Conclusion:The history of CVE and the high signal intensity of T2-Mr are the risk factors of rp-CSM.Despite the rapid deterioration of neurological function,patients with rp-CSM showed a good recovery of neurological function after operation,indicating that rp-CSM is a reversible disease.