Whether Carotid Atherosclerosis Affects Preoperative Symptoms And Postoperative Outcomes In Patients With Cervical Spondylotic Myelopathy

Objective:(1)To explore the influence of carotid atherosclerosis on the preoperative clinical symptoms,postoperative efficacy and improvement of neurological scores of patients with cervical spondylotic myelopathy who received ACDF surgery;(2)To explore whether preoperative routine carotid ultrasound is needed for patients with cervical spondylotic myelopathy.Materials and methods: This study included the data of 31 patients with cervical spondylotic myelopathy admitted to the Department of Orthopedics of the Union Hospital Affiliated to Fujian Medical University on January 1,2019 and January 31,2020,who underwent ACDF surgery in our hospital,All the patients receiving ACDF were examined by carotid artery color Doppler ultrasonography preoperatively,among which 16 cases(group A)showed carotid atherosclerosis,and 15 cases(group B) showed no obvious abnormality in color Doppler ultrasonography.Using Pearson,Spearman correlation analysis,nonparametric test,linear regression analysis method compared two groups of patients with preoperative JOA score,preoperative NDI score,preoperative dizziness and headache,operation time,intraoperative blood loss,postoperative flow,hospitalization days and postoperative JOA improvement rate and other indicators,and analyze whether carotid atherosclerosis affects the preoperative symptoms and postoperative efficacy of patients with cervical spondylotic myelopathy.Results: In this study,31 patients with cervical spondylotic myelopathy were included,including 20 males and 11 females,with an average age of 57.1±10.8 years.The postoperative follow-up was 12 months.Among them,there were 16 patients(group A) with B ultrasound suggesting carotid atherosclerosis,and 15 patients(group B)with no abnormal carotid artery.We found that there were statistically significant differences in age,sex,hypertension,dizziness,and postoperative drainage volume between the two groups(P&L;0.05),which indicated that carotid atherosclerosis would lead to preoperative dizziness symptoms,and lead to increased postoperative drainage;At the same time,older patients,males,and patients with hypertension are more likely to develop carotid atherosclerosis.In order to better evaluate the postoperative efficacy of patients with cervical spondylotic myelopathy,we found that surgical treatment was effective for all patients according to the postoperative improvement rate of JOA.Pearson test was further used to evaluate the possible preoperative factors related to the improvement rate of JOA.We found that the preoperative JOA was negatively correlated with the improvement rate of JOA 1 month,6 months and 1 year after surgery.These results indicated that surgical treatment could significantly improve the symptoms of spinal cord compression,further demonstrating the effectiveness of surgical treatment.Meanwhile,through linear regression analysis,we found that there was a linear relationship between the improvement rate of JOA before surgery and that of JOA 1 month,6 months and 1 year after surgery,and the regression equation was Y=-2.0784X+64.003,Y=-3.2115X+89.068 and Y=-2.4114X+04.12,respectively.In addition,we found that in patients with cervical spondylotic myelopathy,patients with preoperative headache and long postoperative hospital stay had a worse JOA improvement rate one year after surgery,In other words,the long-term outcome is poor.Conclusion:In patients with cervical spondylotic myelopathy,carotid atherosclerosis may lead to preoperative dizziness and postoperative increased drainage.At the same time,carotid atherosclerosis does not affect the postoperative efficacy of ACDF surgery in patients with cervical spondylotic myelopathy,but the older,male and hypertensive patients are more likely to develop carotid atherosclerosis.Therefore,in clinical practice,carotid ultrasound should be routinely performed for such patients.