• Lindsay Tetreault, Gamaliel Tan, Branko Kopjar, Pierre Côté, Paul Arnold, Natalia Nugaeva, Giuseppe Barbagallo, and Michael G Fehlings.
• *Institute of Medical Sciences, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; ‡Department of Orthopaedics, Alexandra Hospital (Juronghealth), Singapore; §Department of Health Services, University of Washington, Seattle, Washington; ¶Faculty of Health Sciences, University of Ontario Institute of Technology (UOIT), UOIT-CMCC Centre for the Study of Disability Prevention and Rehabilitation, Oshawa, Ontario, Canada; ‖Department of Neurosurgery, University of Kansas, Lawrence, Kansas; #Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; **Department of Neurosurgery, University Hospital Catania, Catania, Italy; ‡‡Halbert Chair in Neural Repair and Regeneration, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
• Neurosurgery. 2016 Jul 1; 79 (1): 33-44.

BackgroundSurgery for cervical spondylotic myelopathy (CSM) is generally safe and effective. Nonetheless, complications occur in 11% to 38% of patients. Knowledge of important predictors of complications will help clinicians identify high-risk patients and institute prevention and management strategies.ObjectiveTo identify clinical and surgical predictors of perioperative complications in CSM patients.MethodsFour hundred seventy-nine surgical CSM patients were enrolled in the prospective CSM-International study at 16 sites. A panel of physicians reviewed all adverse events and classified each as related or unrelated to surgery. Univariate analyses were performed to determine differences between patients who experienced a perioperative complication and those who did not. A complication prediction rule was developed using multiple logistic regression.ResultsSeventy-eight patients experienced 89 perioperative complications (16.25%). On univariate analysis, the major clinical risk factors were ossification of the posterior longitudinal ligament (OPLL) (P = .055), number of comorbidities (P = .002), comorbidity score (P = .006), diabetes mellitus (P = .001), and coexisting gastrointestinal (P = .039) and cardiovascular (P = .046) disorders. Patients undergoing a 2-stage surgery (P = .002) and those with a longer operative duration (P = .001) were at greater risk of perioperative complications. A final prediction model consisted of diabetes mellitus (odds ratio [OR] = 1.96, P = .060), number of comorbidities (OR = 1.20, P = .069), operative duration (OR = 1.07, P = .002), and OPLL (OR = 1.75, P = .040).ConclusionSurgical CSM patients have a higher risk of perioperative complications if they have a greater number of comorbidities, coexisting diabetes mellitus, OPLL, and a longer operative duration. Surgeons can use this information to discuss the risks and benefits of surgery with patients, to plan case-specific preventive strategies, and to ensure appropriate management in the perioperative period.AbbreviationsBMI, body mass indexCSM, cervical spondylotic myelopathymJOA, modified Japanese Orthopaedic AssociationOPLL, ossification of the posterior longitudinal ligament.

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