Rajshekhar Vedantam, Kumar G Samson Sujith
Department of Neurological Sciences, Christian Medical College, Vellore, India.
Neurosurgery. 2005 Jun;56(6):1279-84; discussion 1284-5. doi: 10.1227/01.neu.0000159713.20597.0f.
We studied the long-term functional outcome in poor-grade patients (Nurick Grades 4 and 5) with cervical spondylotic myelopathy (CSM) or ossified posterior longitudinal ligament after central corpectomy (CC). We sought to determine whether there were any prognostic factors that could predict functional outcome in these patients.
Functional outcome data were collected for 72 patients (68 men and 4 women; mean age, 49.7 yr; range, 30-67 yr) with CSM (60 patients) or OPLL (12 patients) of Nurick Grades 4 (55 patients) and 5 (17 patients). Uninstrumented CC was performed at 1 level in 12 patients, at 1 level combined with a discoidectomy at another level in 4 patients, at 2 levels in 50 patients, and at 2 levels plus a discoidectomy in 5 patients. The age at presentation (< or =50 yr or >50 yr), grade before surgery (4 or 5), the number of levels operated (1 or >1), diagnosis (CSM or ossified posterior longitudinal ligament), and duration of myelopathic symptoms (< or =12 mo or >12 mo) were studied for their effect on the functional outcome noted at the last follow-up. Functional outcome was graded as poor (no change in Nurick grade), fair (improvement of one Nurick grade), good (improvement of two Nurick grades), and cure (follow-up Nurick grade of 0 or 1).
The follow-up ranged from 9 to 104 months (mean, 36.3 mo). One patient died 3 weeks after CC after surgery for a perforated duodenal ulcer. There was transient operative morbidity in 12 patients (16.9%). The mean Nurick score improved from 4.24 to 2.47 (P < 0.001). Of the 54 patients (76%) who improved in their Nurick grade, the functional outcome was graded as fair in 13 patients (18.3%), good in 24 patients (33.8%), and cure in 17 patients (23.9%). The functional outcome was poor in 17 patients (23.9%). Functional improvement after CC was uniformly correlated with myelopathic symptoms of 12 months' duration or shorter. The other favorable prognostic indicators for improvement after CC were a diagnosis of CSM and preoperative Nurick Grade 5; however, patients with a preoperative Nurick grade of 4 were more likely to experience a cure.
More than three-fourths of patients with poor-grade CSM improve in their functional status after CC, with nearly 24% of patients obtaining a cure. Because patients with a duration of myelopathic symptoms of 12 months or less had the best functional outcome, early decompressive surgery should be offered to patients with poor-grade CSM.
我们研究了颈椎病性脊髓病（CSM）或后纵韧带骨化症的低级别患者（努里克分级4级和5级）在椎体次全切除术后（CC）的长期功能预后。我们试图确定是否存在任何可预测这些患者功能预后的预后因素。
收集了72例患者（68例男性和4例女性；平均年龄49.7岁；范围30 - 67岁）的功能预后数据，这些患者患有CSM（60例）或努里克分级4级（55例）和5级（17例）的后纵韧带骨化症（OPLL）。12例患者在1个节段进行了非内固定CC，4例患者在1个节段联合另一个节段的椎间盘切除术，50例患者在2个节段，5例患者在2个节段加椎间盘切除术。研究了就诊时年龄（≤50岁或＞50岁）、术前分级（4级或5级）、手术节段数（1个或＞1个）、诊断（CSM或后纵韧带骨化症）以及脊髓病症状持续时间（≤12个月或＞12个月）对末次随访时功能预后的影响。功能预后分为差（努里克分级无变化）、尚可（努里克分级改善1级）、良好（努里克分级改善2级）和治愈（随访时努里克分级为0或1级）。
随访时间为9至104个月（平均36.3个月）。1例患者在CC术后3周因十二指肠溃疡穿孔死亡。12例患者（16.9%）出现短暂的手术并发症。努里克平均评分从4.24提高至2.47（P＜0.001）。在努里克分级改善的54例患者（76%）中，功能预后评为尚可的有13例（18.3%），良好的有24例（33.8%），治愈的有17例（23.9%）。17例患者（23.9%）的功能预后差。CC术后的功能改善与持续时间为12个月或更短的脊髓病症状一致相关。CC术后改善的其他有利预后指标为CSM诊断和术前努里克5级；然而，术前努里克分级为4级的患者更有可能治愈。
超过四分之三的低级别CSM患者在CC术后功能状态得到改善，近24%的患者治愈。由于脊髓病症状持续时间为12个月或更短的患者功能预后最佳，应向低级别CSM患者提供早期减压手术。
