Effect of vitamin D deficiency on surgical outcomes of degenerative cervical myelopathy

Hiroyuki Inose; Takuya Takahashi; Yu Matsukura; Jun Hashimoto; Kurando Utagawa; Satoru Egawa; Kentaro Yamada; Takashi Hirai; Kunihiko Takahashi; Toshitaka Yoshii

doi:10.1016/j.xnsj.2023.100239

Effect of vitamin D deficiency on surgical outcomes of degenerative cervical myelopathy

N Am Spine Soc J. 2023 Jun 28:15:100239. doi: 10.1016/j.xnsj.2023.100239. eCollection 2023 Sep.

Authors

Affiliations

¹ Department of Orthopedic and Trauma Research, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo 113-8519, Japan.
² Department of Orthopaedic Surgery, Dokkyo Medical University Saitama Medical Center, 2-1-50 Minamikoshigaya, Koshigaya-shi, Saitama 343-8555, Japan.
³ Department of Orthopedics, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
⁴ Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.

Abstract

Background: Due to its association with bone metabolic status and muscle strength/mass, vitamin D deficiency has the potential to affect neurological symptom recovery after surgery for degenerative cervical myelopathy (DCM). However, few studies have investigated the effects of vitamin D deficiency (serum 25(OH)D <20 ng/mL) on surgical outcomes in DCM patients. Herein, we investigated the prevalence of vitamin D deficiency in patients with DCM, and determined whether vitamin D deficiency affects surgical outcomes for DCM.

Methods: In this retrospective observational study we assessed the recovery rate 1 year after surgery in 91 patients diagnosed with DCM who underwent surgery. First, we analyzed the correlation between vitamin D levels and various background factors. Then, patients were divided into 2 groups according to vitamin D sufficiency, and univariate analysis was performed on vitamin D and surgical outcomes. Finally, Spearman correlation analyses were performed to identify factors correlated with recovery rate after surgery for DCM.

Results: The average Japanese Orthopedic Association score for the assessment of cervical myelopathy (C-JOA score) improved postoperatively. Age was positively correlated with vitamin D levels, and parathyroid hormone levels were negatively correlated with vitamin D levels. Among the 91 patients, 79.1% of patients were diagnosed with vitamin D deficiency. No significant differences in recovery rate were found between the vitamin D-deficient and vitamin D-sufficient groups. Finally, the Spearman correlation analysis showed a positive correlation between the preoperative C-JOA motor dysfunction score in the lower extremities and the recovery rate, while age demonstrated a negative correlation with recovery rate.

Conclusions: No association was found between vitamin D deficiency and clinical outcomes after surgery for DCM. The results of this study do not support the need to normalize vitamin D levels for achieving neurological improvements in patients with DCM.

Keywords: C-JOA score; Degenerative cervical Myelopathy; Intact PTH; Outcome; Recovery rate; Vitamin D.