• Satoshi Nori, Narihito Nagoshi, Ryoma Aoyama, Shinichi Ishihara, Kanehiro Fujiyoshi, Yuta Shiono, Kazuya Kitamura, Masayuki Ishikawa, Satoshi Suzuki, Yohei Takahashi, Osahiko Tsuji, Mitsuru Yagi, Masaya Nakamura, Morio Matsumoto, Kota Watanabe, Ken Ishii, and Junichi Yamane.
• Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
• Spine. 2022 Mar 15; 47 (6): 476483476-483.

Study DesignRetrospective multicenter study.ObjectiveTo identify the impact of the intervertebral level of stenosis on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).Summary Of Background DataAs the upper affected cervical levels in elderly patients result from degenerative changes in the lower cervical levels with aging, it is usually difficult to determine the influence of the upper affected cervical levels on surgical outcomes after posterior decompression for CSM in older age.MethodsThis study involved 636 patients with CSM who underwent posterior decompression. According to the most stenotic intervertebral level, patients were divided into upper (n = 343, the most stenotic intervertebral level was C2/3, C3/4, or C4/5) and lower (n = 293, the most stenotic intervertebral level was C5/6, C6/7, or C7/T1) cervical stenosis groups. Propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed to compare surgical outcomes, the Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for neck pain between the upper (n = 135) and lower (n = 135) cervical stenosis groups.ResultsBefore propensity score matching, age at surgery was older and pre- and postoperative JOA scores were lower in the upper cervical stenosis group (P < 0.001, P < 0.001, and P < 0.001, respectively). Following matching, baseline factors were comparable between the groups. Postoperative JOA scores, preoperative-to-postoperative changes in the JOA scores, and the JOA score recovery rate were not significantly different between the groups (P = 0.866, P = 0.825, and P = 0.753, respectively). No differences existed in postoperative VAS for neck pain and preoperative-to-postoperative changes in VAS for neck pain between the groups (P = 0.092 and P = 0.242, respectively).ConclusionThe intervertebral level of stenosis did not affect surgical outcomes after posterior decompression for CSM.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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