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Cervical Decompression Surgery for Cervical Spondylotic Myelopathy and Concomitant Hypertension: A Multicenter
Liang Yang1,2, Cheng Yang3, Xiaodong Pang4
1Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Insights
Cervical decompression surgery significantly lowers blood pressure in patients with cervical spondylotic myelopathy (CSM) and hypertension. This blood pressure reduction is linked to improved spinal cord function, offering a new perspective on managing comorbid conditions in CSM patients.
Area of Science:
- Neurosurgery
- Cardiology
- Orthopedics
Background:
- Concomitant hypertension is frequently observed in patients with cervical spondylotic myelopathy (CSM).
- Successful surgical decompression for CSM has been anecdotally linked to normalization of blood pressure in some hypertensive patients, even without medication.
Purpose of the Study:
- To investigate the effect of decompression surgery on hypertension in CSM patients.
- To determine if improvements in blood pressure correlate with enhanced spinal cord function or reduced cervical pain.
Main Methods:
- A study involving 135 CSM patients with hypertension, comparing decompression surgery (103 patients) with conservative treatments (32 patients).
- Follow-up assessments at 3, 6, and 12 months evaluated changes in blood pressure, modified Japanese Orthopedic Association (mJOA) scores, and cervical pain (VAS).
- Spearman correlation analysis examined the relationship between changes in systolic blood pressure (SBP) and mJOA/VAS scores.
Main Results:
- Decompression surgery led to a significant and sustained decrease in both systolic and diastolic blood pressure from 3 to 12 months post-procedure (P < 0.001).
- A significant negative correlation was observed between the improvement rate of mJOA scores and changes in SBP (r = -0.579, P < 0.001).
- No significant correlation was found between changes in cervical pain VAS scores and changes in SBP (r = 0.58, P = 0.571).
Conclusions:
- Cervical decompression surgery is effective in reducing concomitant hypertension in CSM patients.
- The study indicates a significant association between surgical decompression, blood pressure reduction, and improvement in spinal cord function in CSM patients.
Study Design:
We performed decompression surgery or conservative treatments on 135 cervical spondylotic myelopathy (CSM) patients with concomitant hypertension and did follow-up assessments up to 1 year to examine the change of blood pressure, spinal cord function, and cervical pain.
Objective:
The aim of this study was to determine whether concomitant hypertension is relieved after decompression surgery, and whether it is related to the improvement of spinal cord function or cervical pain.
Summary Of Background Data:
In clinical practice, we often found that some patients with CSM have concomitant hypertension. Interestingly, after CSM was treated successfully by decompression surgery, some patients' high blood pressure returned to normal range even without oral medications.
Methods:
We enrolled 135 CSM patients with hypertension, 103 of whom received decompression surgery, and remaining 32 patients accepted conservative treatments. We did follow-up assessments at 3, 6, and 12 months. The primary endpoints were changes of blood pressure, and secondary endpoints were changes of modified Japanese Orthopedic Association (mJOA) score and cervical pain visual analogue scale (VAS). Spearman correlation coefficients were calculated between changes in systolic blood pressure (SBP) and mJOA scores, VAS scores.
Results:
In patients with decompression surgery, the significant decrease in both SBP and diastolic blood pressure (DBP) that was seen 3 months and sustained through subsequent visit at 12 months. Paired-samples t test showed that both SBP and DBP were significantly lower than baseline blood pressure at all time points after procedure (P < 0.001). Significant correlation was found between the improvement rates of mJOA score and changes in SBP (r = -0.579, P < 0.001). But the correlation between changes in VAS score and changes in SBP was not significant (r = 0.58, P = 0.571).
Conclusion:
Cervical decompression surgery could reduce concomitant high blood pressure in CSM patients, indicating a significant association between the decrease in blood pressure and the improvement of spinal cord function.
Level Of Evidence:
2.
