Risk of posterior circulation stroke in patients with cervical spondylosis: A nationwide, population-based study. (October 2018)

• Record Type: Journal Article
• Authors: Lin, Shih-Yi; Lin, Cheng-Li; Chen, Der-Cherng; Lee, Han-Chung; Chen, Hsien-Te; Lin, Tsung-Chih; Hsu, Chung-Y.; Kao, Chia-Hung
• Is Part Of: Atherosclerosis. Volume 277(2018)
• Page Start: 42
• Page End: 46
• Publication Date: 2018-10
• Subjects: Cervical spondylosis -- Posterior circulation ischemic stroke -- Cohort study; CS Cervical spondylosis -- HRs hazard ratios -- CI confidence interval -- VB vertebrobasilar -- NHIRD National Health Insurance Research Database -- LHID2000 Longitudinal Health Insurance Database 2000 -- ICD-9-CM International Classification of Diseases, Ninth Revision, Clinical Modification; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2018.08.006
• Languages: English
• ISSNs: 0021-9150

Abstract

Abstract: Background and aims: Cervical spondylosis (CS) is reported to be associated with vertebrobasilar insufficiency. However, few cohort studies have investigated the association between CS and posterior circulation ischemic stroke. Methods: The study cohort comprised 27, 990 patients aged ≥18 years with a first diagnosis of CS. The controls consisted of patients with propensity score matched for age, sex, and comorbidities at a ratio of 1:1. We investigated the relationships of CS with ischemic stroke and all-cause mortality. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The average follow-up duration was 6.13 (SD = 3.18) and 6.07 (SD = 3.19) years in the CS and non-CS cohorts, respectively. Results: The mean age of CS patients and non-CS patients was 54.9 ± 13.4 and 55.1 ± 14.9 years. Fifty-eight point five percent of CS patients and 59.2% of non-CS patients were women. CS patients were 1.46 folds more likely to develop a posterior circulation ischemic stroke (95% CI, 1.23–1.72) than non-CS patients. CS patients with myelopathy exhibited a 1.50–fold risk (95% CI, 1.21–1.86) of posterior circulation ischemic stroke compared with non-CS patients; CS patients without myelopathy were at a 1.43-fold risk (95% CI, 1.18–1.73) of posterior ischemic stroke compared with non-CS patients. The risk of posterior ischemic stroke was non-significant between non-CS patients and CS patients who had received spinal anterior decompression (adjusted HR, 1.66; 95% CI, 0.78–3.52), while receiving posterior decompression was associated with a 4.23-fold risk of posterior ischemic stroke (95% CI, 1.05–17.0). Conclusions: This population-based study showed that CS is associated with an increased risk of posterior circulation ischemic stroke. Surgical posterior decompression was associated with the highest risk of posterior ischemic stroke. Highlights: CS patients were 1.46-fold more likely to develop a posterior circulation ischemic stroke than were the non-CS patients. CS patients with myelopathy exhibited a 1.50-fold risk of posterior circulation ischemic stroke compared with non-CS patients.