2121 Incidence, Risk Factors and Long-Term Consequence of Neurological Complication and Symptom Worsening After Surgery for Degenerative Cervical Myelopathy (DCM): Evidence for a Protective Effect of the Sodium-Glutamate Antagonist Riluzole

INTRODUCTION: Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord dysfunction in adults worldwide. While surgery for DCM has demonstrated efficacy in improving outcomes and enhancing quality of life, it carries inherent risks, including postoperative neurological complications. METHODS: Patients diagnosed with moderate to severe DCM were enrolled as part of the prospective CSM-PROTECT trial between 2012 and 2017. The primary outcome was postoperative neurological deterioration and symptom worsening, defined as the occurrence of postoperative C5 palsy, nerve root injury, worsening myelopathic symptoms, or the development of new numbness, neck, and shoulder pain. Outcomes were evaluated at one-year post-surgery. A multivariable logistic regression analysis was performed to determine significant predictors of postoperative neurological complications. RESULTS: Among the 290 patients enrolled (mean age 57.95 years, 44.5% females, mean baseline mJOA = 11.91), 117 (40.34%) experienced postoperative neurological complications. Majority of patients who developed postoperative numbness, root injury, and pain fully recovered without residual symptoms at one year (60%, 38.10%, 47.17%, respectively). Long term outcomes did not differ significantly between patients with and without neurological deterioration (mJOA p=0.235, Nurick p=0.643, Neck pain NRS p=0.873, Arm pain NRS p=0.274, ?SF-36 PCS p=0.639, SF-36 MCS p=0.498). Significant predictors for neurological deterioration included the use of neuroprotective agent (OR: 0.58, p=0.03), non-frailty (OR: 0.40, p=0.004), and smoking (OR: 1.77, p=0.026). CONCLUSIONS: The use of neuroprotective agent (i.e., riluzole), non-frailty, and non-smoking status were associated with a reduced risk of postoperative neurological deterioration and symptom worsening, independent of surgical approach. Addressing these modifiable risk factors preoperatively may have the potential to optimize outcomes in DCM patients undergoing surgical intervention.