Pascal-Moussellard H, Despeignes L-R, Olindo S, Rouvillain J-L, Catonné Y
Service d'Orthopédie, CHU Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75651 Paris Cedex 13.
Rev Chir Orthop Reparatrice Appar Mot. 2005 Nov;91(7):607-14. doi: 10.1016/s0035-1040(05)84464-2.
PURPOSE OF THE STUDY: Progressive myelopathy secondary to stenosis of the spinal canal is generally treated by surgery. Results of surgical decompression are generally good but the pattern of neurological recovery has not been studied. We followed a cohort of patients who underwent cervical cord decompression to study the course of neurological recovery. MATERIAL AND METHODS: The study cohort included 39 patients (22 men and 17 women), mean age 65.7 years who underwent surgery between 1998 and 2002 for progressive cervical myelopathy. The same surgeon performed all procedures (23 posterior and 16 anterior approaches). The JOA score and MRI findings were noted. The patients were seen at 1, 3, 6, 12, and 18 months then annually (JOA score). The Hirabayashi score was used to assess neurological recovery. Two populations were identified (group 1: preoperative JOA score > 6, group 2: preoperative JOA score<or=6). RESULTS: The mean preoperative JOA score was 8.3/17, range 1-15. Ten patients had a severe JOA score (<6). The mean postoperative JOA score was 13.3 (range 3-17) at six months and remained stable during follow-up. Neurological recovery as assessed with the Hirabayashi technique was 52.5% on average at last follow-up. Neurological gain occurred mostly during the first to third month following decompression, remaining stable thereafter. Patients with a severe deficit exhibited the same recovery pattern but stabilized at a lower neurological level. Expressed in JOA points, neurological gain was very similar in the two groups. There was no significant difference between patients who under went anterior or posterior procedures. DISCUSSION AND CONCLUSION: The pattern of neurological recovery in patients with degenerative cervical disease appears to be rapid during the first six months following surgical decompression. The level of recovery then levels off, irrespective of the severity of the initial deficit. This work demonstrated that more specific evaluation scales than the JOA score should be developed for assessment and follow-up of these patients.
研究目的：继发于椎管狭窄的进行性脊髓病通常采用手术治疗。手术减压的效果总体良好，但神经功能恢复模式尚未得到研究。我们对一组接受颈髓减压的患者进行随访，以研究神经功能恢复过程。 材料与方法：研究队列包括39例患者（22例男性和17例女性），平均年龄65.7岁，于1998年至2002年间因进行性颈髓病接受手术。所有手术均由同一位外科医生完成（23例后路手术和16例前路手术）。记录JOA评分和MRI检查结果。患者在术后1、3、6、12和18个月就诊，之后每年就诊一次（JOA评分）。采用平林评分评估神经功能恢复情况。确定了两个亚组（第1组：术前JOA评分>6，第2组：术前JOA评分≤6）。 结果：术前JOA评分平均为8.3/17，范围为1-15。10例患者JOA评分严重（<6）。术后6个月JOA评分平均为13.3（范围3-17），随访期间保持稳定。末次随访时，采用平林技术评估的神经功能恢复平均为52.5%。神经功能改善主要发生在减压后的第1至3个月，此后保持稳定。严重神经功能缺损的患者表现出相同的恢复模式，但在较低的神经功能水平稳定下来。以JOA评分表示，两组患者的神经功能改善非常相似。接受前路或后路手术的患者之间无显著差异。 讨论与结论：退行性颈椎病患者的神经功能恢复模式在手术减压后的前6个月似乎较快。随后恢复水平趋于平稳，与初始缺损的严重程度无关。这项研究表明，应为这些患者的评估和随访开发比JOA评分更具特异性的评估量表。
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