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减压手术对伴有压迫性颈髓病的脊髓结节病是否有效?

Is decompressive surgery effective for spinal cord sarcoidosis accompanied with compressive cervical myelopathy?

机构信息

Department of Orthopaedic Surgery, Nagoya University School of Medicine, Aichi Prefecture, Japan.

出版信息

Spine (Phila Pa 1976). 2010 Nov 1;35(23):E1290-7. doi: 10.1097/BRS.0b013e3181e6d592.

Abstract

STUDY DESIGN

A retrospective multicenter study of series of 12 patients with spinal cord sarcoidosis who underwent surgery.

OBJECTIVE

To evaluate the postoperative outcomes of patients with cervical spinal cord sarcoidosis accompanied with compressive myelopathy and effect of decompressive surgery on the prognosis of sarcoidosis.

SUMMARY OF BACKGROUND DATA

Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease. It is difficult to differentiate spinal cord sarcoidosis from cervical compressive myelopathy. There are no studies regarding the coexistence of compressive cervical myelopathy with cervical spinal cord sarcoidosis and the effect of decompressive surgery.

METHODS

Nagoya Spine Group database included 1560 cases with cervical myelopathy treated with cervical laminectomy or laminoplasty from 2001 to 2005. A total of 12 patients (0.08% of cervical myelopathy) were identified spinal cord sarcoidosis treated with decompressive surgery. As a control subject, 8 patients with spinal cord sarcoidosis without compressive lesion who underwent high-dose steroid therapy without surgery were recruited.

RESULTS

In the surgery group, enhancing lesions on magnetic resonance imaging (MRI) were mostly seen at C5-C6, coincident with the maximum compression level in all cases. Postoperative recovery rates in the surgery group at 1 week and 4 weeks were -7.4% and -1.1%, respectively. Only 5 cases had showed clinical improvement, and the condition of these 5 patients had worsened again at averaged 7.4 weeks after surgery. Postoperative oral steroid therapy was initiated at an average of 6.4 weeks and the average initial dose was 54.0 mg in the surgery group, while 51.3 mg in the nonsurgery group. The recovery rate of the Japanese Orthopedic Association score, which increased after steroid therapy, was better in the nonsurgery group (62.5%) than in the surgery group (18.6%) with significant difference (P < 0.01).

CONCLUSION

The effect of decompression for spinal cord sarcoidosis with compressive myelopathy was not evident. Early diagnosis for sarcoidosis from other organ and steroid therapy should be needed.

摘要

研究设计

回顾性多中心研究,共纳入 12 例接受手术治疗的脊髓结节病患者。

目的

评估伴有压迫性脊髓病的颈段脊髓结节病患者的术后转归,以及减压手术对结节病预后的影响。

背景资料总结

结节病是一种慢性、多系统非干酪样肉芽肿性疾病。脊髓结节病很难与颈段压迫性脊髓病相鉴别。目前尚无关于颈段压迫性脊髓病合并颈段脊髓结节病的共存以及减压手术效果的研究。

方法

名古屋脊柱研究组数据库纳入了 2001 年至 2005 年间接受颈椎椎板切除术或椎板成形术治疗的 1560 例颈脊髓病患者。共发现 12 例(0.08%的颈脊髓病)接受减压手术治疗的脊髓结节病患者。作为对照组,招募了 8 例无压迫性病变的脊髓结节病患者,这些患者未接受手术,仅接受大剂量类固醇治疗。

结果

在手术组中,磁共振成像(MRI)上的增强病变主要见于 C5-C6 节段,与所有病例的最大压迫水平一致。手术组在术后 1 周和 4 周时的恢复率分别为-7.4%和-1.1%。仅有 5 例患者出现临床改善,且这 5 例患者在术后平均 7.4 周时病情再次恶化。术后开始口服类固醇治疗的时间平均为 6.4 周,手术组的初始剂量平均为 54.0mg,非手术组为 51.3mg。经类固醇治疗后日本矫形协会评分(Japanese Orthopedic Association score)升高,非手术组的恢复率(62.5%)优于手术组(18.6%),差异有统计学意义(P<0.01)。

结论

对于伴有压迫性脊髓病的脊髓结节病,减压治疗效果不明显。早期从其他器官诊断结节病并进行类固醇治疗可能是必要的。

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