Persistent Outpatient Hypertension Is Independently Associated with Spinal Cord Dysfunction and Imaging Characteristics of Spinal Cord Damage among Patients with Cervical Spondylosis

Authors

Samuel Kalb, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Hasan A. Zaidi, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Juan C. Ribas-Nijkerk, Division of Neurological Surgery, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canarias, Spain.
Maughan K. Sindhwani, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Justin C. Clark, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Nikolay L. Martirosyan, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Nicholas Theodore, Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.

Document Type

Article

Abstract

OBJECTIVE: Hypertension and cervical spondylosis are diseases of the adult population that are approaching near pandemic proportions. However, the interactions between these two disease processes are poorly understood. We set out to determine the associations among systemic hypertension, clinical status, and imaging findings of spinal cord damage for patients with cervical stenosis. METHODS: A retrospective chart review was performed on patients with symptomatic cervical stenosis related to degenerative disease and divided on the basis of outpatient blood pressure control (normal <140/<90 mm Hg). Sagittal T2-weighted magnetic resonance imaging (MRI) of the cervical spine was analyzed to determine the degree of maximal canal stenosis (MCS; %), surface area of increased signal intensity (ISI; cm(2)), and signal intensity ratio (SIR). Functional status was evaluated using the modified Japanese Orthopaedic Association (mJOA) scale and the Nurick scale. RESULTS: One hundred twenty-two patients were identified (64 hypertensive, 58 nonhypertensive). Likelihood of ISI was higher in hypertensive patients (P < 0.05). Average ISI was significantly higher in patients with uncontrolled blood pressure (P = 0.02) despite MCS being identical between the two groups. The mJOA and Nurick scores were worse for patients with systemic hypertension (P < 0.02). Diabetes mellitus and smoking history did not affect these findings. CONCLUSIONS: Persistent hypertension in outpatients is associated with worsened clinical status and increased markers of spinal cord damage on MRI. Perioperative management of blood pressure may serve to improve clinical outcomes. Larger prospective trials are necessary to further validate these findings.

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Female; Health Status; Humans; Hypertension (complications, pathology, physiopathology); Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Spinal Cord Compression (etiology, pathology, physiopathology); Spondylosis (complications, pathology, physiopathology)

Publication Date

8-1-2015

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

84

Issue

2

First Page

351

Last Page

7

PubMed ID

25819526

Digital Object Identifier (DOI)

10.1016/j.wneu.2015.03.030

Recommended Citation

Kalb, Samuel; Zaidi, Hasan A.; Ribas-Nijkerk, Juan C.; Sindhwani, Maughan K.; Clark, Justin C.; Martirosyan, Nikolay L.; and Theodore, Nicholas, "Persistent Outpatient Hypertension Is Independently Associated with Spinal Cord Dysfunction and Imaging Characteristics of Spinal Cord Damage among Patients with Cervical Spondylosis" (2015). Neurosurgery. 1711.
https://scholar.barrowneuro.org/neurosurgery/1711