Stoffman Michael R, Roberts Mark S, King Joseph T
Department of Neurosurgery, Yale University, New Haven, Connecticut, USA.
Neurosurgery. 2005 Aug;57(2):307-13; discussion 307-13. doi: 10.1227/01.neu.0000166664.19662.43.
To determine the prevalence of depressed and anxious mood states in patients with cervical spondylotic myelopathy (CSM), a degenerative spine condition with symptoms of neck pain, numb clumsy hands, gait difficulties, sphincter dysfunction, and impotence. To examine the relation between mood and functional deficits produced by CSM.
We surveyed a cohort of 89 patients with CSM recruited during 1 year from a neurosurgery clinic. Patients underwent a structured interview to collect information on demographics, personal habits, CSM symptoms, comorbid diseases, and symptoms of depression and anxiety. Patients self-completed the Hospital Anxiety and Depression scale and were scored on the Nurick, Cooper, Harsh, and modified Japanese Orthopaedic Association (mJOA) scales.
According to the Hospital Anxiety and Depression scale threshold value of 11, 29% of the cohort had a depressed mood and 38% had an anxious mood. Higher depression scores were associated with worse myelopathy, as measured by the Nurick scale (P = 0.01), the Cooper leg subscale (P = 0.006), the Harsh scale (P = 0.02), the mJOA arm subscale (P = 0.006), and the mJOA leg subscale (P = 0.004). There was no relation between depression scores and the Cooper arm subscale, Harsh sphincter scale, mJOA sensory subscale, or mJOA bladder subscale. Similar patterns were seen in the relations between myelopathy and anxiety.
More than one-third of patients with CSM have a depressed or anxious mood. In patients with CSM, depression and anxiety scores are strongly associated with decreased mobility, inconsistently associated with arm dysfunction, and not associated with sensory deficits or sphincter dysfunction, suggesting that ambulatory dysfunction may cause or exacerbate the symptoms of depression and anxiety in patients with CSM.
确定脊髓型颈椎病（CSM）患者中抑郁和焦虑情绪状态的患病率。CSM是一种退行性脊柱疾病，症状包括颈部疼痛、手部麻木笨拙、步态困难、括约肌功能障碍和阳痿。研究CSM导致的情绪与功能缺陷之间的关系。
我们对从神经外科诊所招募的89例CSM患者进行了为期1年的队列研究。患者接受结构化访谈，以收集有关人口统计学、个人习惯、CSM症状、合并疾病以及抑郁和焦虑症状的信息。患者自行完成医院焦虑抑郁量表，并根据Nurick、Cooper、Harsh和改良日本骨科协会（mJOA）量表进行评分。
根据医院焦虑抑郁量表11分的阈值，该队列中29%的患者有抑郁情绪，38%的患者有焦虑情绪。抑郁得分越高，Nurick量表（P = 0.01）、Cooper腿部子量表（P = 0.006）、Harsh量表（P = 0.02）、mJOA手臂子量表（P = 0.006）和mJOA腿部子量表（P = 0.004）测量的脊髓病越严重。抑郁得分与Cooper手臂子量表、Harsh括约肌量表、mJOA感觉子量表或mJOA膀胱子量表之间无相关性。脊髓病与焦虑之间的关系也呈现类似模式。
超过三分之一的CSM患者有抑郁或焦虑情绪。在CSM患者中，抑郁和焦虑得分与活动能力下降密切相关，与手臂功能障碍的相关性不一致，与感觉缺陷或括约肌功能障碍无关，这表明行走功能障碍可能导致或加重CSM患者的抑郁和焦虑症状。
