title: Fall-related Deterioration of Subjective Symptoms in Patients with Cervical Myelopathy.
abstract: METHODS
  Retrospective multi-center study.
  
  
  OBJECTIVE
  This study was conducted to clarify the incidence and neurological outcomes of fall-related deterioration of subjective symptoms in patients undergoing surgical treatment.
  
  
  BACKGROUND
  The evidence that minor trauma, including falls, increases the risk of worsening cervical myelopathy is insufficient.
  
  
  METHODS
  A retrospective analysis of patients who had undergone surgery for cervical myelopathy at 12 participating institutes was conducted. Patients who had undergone surgery for symptomatic cervical myelopathy from January 2012 to December 2013 and completed at least 1-year follow-up were included in this study. Data were collected by chart review and a questionnaire that included numbers of recalled falls during the last preoperative year and first postoperative year, circumstances of falls, and whether the patient had experienced fall-related deterioration of subjective symptoms.
  
  
  RESULTS
  A total of 360 eligible patients were recruited into the study. Of these, 177 (49%) reported at least one fall during the last preoperative year, and 105 (29%) experienced fall-related deterioration of subjective symptoms. Forty (11%) reported deterioration of numbness in the arms or legs, and 65 (18%) reported deterioration of motor deficits. Incidences of falls and fall-related deterioration of symptoms decreased significantly after surgery. Patients who experienced fall-related deterioration of motor deficits showed significantly worse surgical outcomes as assessed by Japanese Orthopaedic Association (JOA) score compared with those who did not experience deterioration. The optimal cut-off for preoperative JOA score in predicting an increased risk of fall-related deterioration in motor deficits was 8.
  
  
  CONCLUSIONS
  Patients with cervical myelopathy commonly experienced preoperative fall-related deterioration of subjective symptoms, associated with significantly worse neurological outcomes. Surgical treatment significantly reduced the incidence of both falls and fall-related deterioration of subjective symptoms.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopaedics, Jichi Medical University.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kimura
authors.affiliation: Department of Orthopedic Surgery, Mitsui Memorial Hospital.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.affiliation: Department of Orthopaedics, Jichi Medical University.
authors.forename: Katsushi
authors.initials: K
authors.lastname: Takeshita
authors.affiliation: Department of Orthopaedics, Jichi Medical University.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Inoue
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical and Dental University.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kato
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical and Dental University.
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Yoshii
authors.affiliation: Department of Orthopedic Surgery, Chiba University Graduate School of Medicine.
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
authors.affiliation: Department of Orthopedic Surgery, Chiba University Graduate School of Medicine.
authors.forename: Masao
authors.initials: M
authors.lastname: Koda
authors.affiliation: Department of Orthopedic Surgery, National Hospital Organization Okayama Medical Center.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Department of Orthopedic Surgery, Imakiire General Hospital.
authors.forename: Shunji
authors.initials: S
authors.lastname: Matsunaga
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, University of Toyama.
authors.forename: Shoji
authors.initials: S
authors.lastname: Seki
authors.affiliation: Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Yoshimoto
authors.initials: Y
authors.lastname: Ishikawa
authors.affiliation: Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.affiliation: Department of Orthopedic Surgery, Faculty of Medicine, University of Tsukuba.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.affiliation: Department of Orthopedic Surgery, Shiga University of Medical Science.
authors.forename: Kanji
authors.initials: K
authors.lastname: Mori
authors.affiliation: Department of Orthopedic Surgery, Mitsui Memorial Hospital.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Kawasaki
authors.affiliation: Department of Orthopedic Surgery, University of Yamanashi.
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.affiliation: Department of Orthopaedic Surgery, Tokyo Medical University.
authors.forename: Kenji
authors.initials: K
authors.lastname: Endo
authors.affiliation: Department of Orthopaedic Surgery, Kurume University School of Medicine.
authors.forename: Kimiaki
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Orthopedic Surgery, Tokyo Medical and Dental University.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Okawa
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery*; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000175:diagnosis* / Q000601:surgery*