Impact of internal carotid artery thickness on postoperative cognitive function in cervical spondylotic myelopathy patients

Cervical spondylotic myelopathy(CSM) is a prevalent degenerative disorder, with anterior cervical discectomy and decompression as the primary treatment. However, some patients may develop postoperative cognitive dysfunction (POCD). Carotid artery intima-media thickness (IMT), an early marker of carotid atherosclerosis, could be linked to changes in cerebral blood flow and cognitive function after surgery. The study included patients with cervical spondylotic myelopathy scheduled for anterior cervical discectomy and decompression. Based on preoperative carotid artery IMT measurements, patients were divided into two groups: high IMT (>0.9 mm) and low IMT (≤0.9 mm). Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) before surgery and at 1 week, 1 month, and 3 months after surgery. T-tests and multiple regression analyses were used to compare cognitive changes between groups, adjusting for confounding factors. The study included 100 patients, with 40 in the high IMT group and 60 in the low IMT group. At 1 week post-surgery, the MoCA scores in the high IMT group were significantly lower than those in the low IMT group (P＜0.05). However, no significant differences in cognitive function were observed between the two groups at 1 month and 3 months post-surgery, with both groups improving (P＞0.05). Elevated carotid IMT is associated with increased POCD risk after Anterior cervical discectomy and decompression (ACDF) in CSM patients. Preoperative IMT assessment may help predict POCD and guide personalized perioperative care.