Abstract
OBJECTIVE: To identify the risk factors that influence the prognosis of patients with cervical spondylotic myelopathy (CSM). METHODS: Clinical data were collected from 158 CSM patients treated between January 2023 and January 2024 at a tertiary medical center. The data were retrospectively analyzed, with a 1-year follow-up. Based on the Japanese Orthopaedic Association (JOA) score, patients were categorized into good and poor recovery groups. Clinical characteristics, laboratory indices, and imaging findings were compared between the groups, and risk factors affecting CSM prognosis were identified. RESULTS: In a multivariable analysis, age, symptom duration, preoperative JOA score, spinal cord compression ratio, regulatory T cell (Treg) cell count, the number of surgical levels and diabetes history were identified as significant predictors of postoperative outcomes. Interestingly, Treg cell counts showed a novel positive correlation with improvement rates (p<0.001), suggesting their potential role in spinal cord recovery after surgery. CONCLUSION: These findings underscore the prognostic relevance of clinical and immunological factors for predicting surgical outcomes in CSM. The observed association between peripheral Treg counts and recovery rates reveals new insights into the immunological mechanisms underlying CSM prognosis, suggesting potential targets for personalized treatment strategies.