Holly Langston T, Matz Paul G, Anderson Paul A, Groff Michael W, Heary Robert F, Kaiser Michael G, Mummaneni Praveen V, Ryken Timothy C, Choudhri Tanvir F, Vresilovic Edward J, Resnick Daniel K
Division of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, California, USA.
J Neurosurg Spine. 2009 Aug;11(2):112-8. doi: 10.3171/2009.1.SPINE08718.
The objective of this systematic review was to use evidence-based medicine to assess whether clinical factors predict surgical outcomes in patients undergoing cervical surgery.
The National Library of Medicine and Cochrane Database were queried using MeSH headings and keywords relevant to clinical preoperative factors. Abstracts were reviewed, and studies that met the inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons.
Preoperative sensory-evoked potentials may aid in providing prognostic information in selected patients in whom clinical factors do not provide clear guidance (Class II). Age, duration of symptoms, and preoperative neurological function may commonly affect outcome (Class III).
Age, duration of symptoms, and preoperative neurological function should be discussed with patients when surgical intervention for cervical spondylotic myelopathy is considered. Preoperative sensory-evoked potentials may be considered for patients in whom clinical factors do not provide clear guidance if such information would potentially change therapeutic decisions.
本系统评价的目的是运用循证医学评估临床因素是否可预测接受颈椎手术患者的手术结局。
使用与临床术前因素相关的医学主题词和关键词在国立医学图书馆及考克兰数据库中进行检索。对摘要进行评审，并选取符合纳入标准的研究。指南小组编制了一个证据表，总结证据质量（I - III级）。关于证据水平的分歧通过专家共识会议解决。该小组根据苏格兰校际指南网络制定了包含推荐强度的建议。通过美国神经外科医师协会/神经外科医师大会联合指南委员会的同行评审进行验证。
术前感觉诱发电位可能有助于为某些临床因素无法提供明确指导的特定患者提供预后信息（II级）。年龄、症状持续时间和术前神经功能通常可能影响手术结局（III级）。
在考虑对脊髓型颈椎病进行手术干预时，应与患者讨论年龄、症状持续时间和术前神经功能。如果此类信息可能改变治疗决策，对于临床因素无法提供明确指导的患者，可考虑进行术前感觉诱发电位检查。
