Department of Orthopaedic Surgery, Hyogo Rehabilitation Center Hospital, Kobe, Japan.
Spine (Phila Pa 1976). 2013 Jan 15;38(2):104-11. doi: 10.1097/BRS.0b013e318267af02.
Retrospective study.
To examine the prevalence of lower urinary tract symptoms (LUTS) and neurogenic bladder (NB), and surgical outcomes in pure cervical spondylotic myelopathy.
The inclusion of various types of cervical diseases, NB, and no obvious definition of NB provided the wide range of NB prevalence frequency among previous reports.
Of the 220 operated patients with cervical myelopathy, 54 were selected by excluding other cervical and/or concomitant diseases contributing to LUTS. All patients with LUTS were referred to urologists and recommended to undergo urodynamic study (UDS). The presence of NB was judged by abnormal findings of UDS according to the most recent criteria and a congruity between LUTS and the course of cervical myelopathy. Patients were divided into 4 groups: no symptoms, positive symptoms without UDS examination, positive symptoms with positive NB, and positive symptoms with negative NB. Evaluation scores were compared among the groups before and after surgery.
There were no particular LUTS in NB patients. Prevalence of LUTS was 53.7% and that of NB was at least 20.4% in the patients with pure cervical spondylotic myelopathy. The scores of all 4 groups improved after surgery (P < 0.05); however, the recovery rate of NB group (47.1%) was the worst among the groups (no-symptoms group, 69.3%; negative-NB group, 53.5%; and positive symptoms without UDS group, 57.1%). Preoperative part scores showed no difference among the groups, whereas NB group demonstrated lower scores in finger and lower extremity postoperatively. A post hoc analysis confirmed a significantly poorer recovery rate related to the NB group only in the lower extremities.
This study is the first to describe the prevalence of LUTS and NB according to the most recent criteria in patients with pure cervical spondylotic myelopathy, which demonstrated that neurological functions in NB patients may recover; however, the extent will be limited to two-thirds of those in patients with no-NB; moreover, the remaining symptoms derive from poor lower limb function.
回顾性研究。
检查单纯性颈椎病患者下尿路症状（LUTS）和神经源性膀胱（NB）的发生率和手术结果。
由于以往报告中包含了各种类型的颈椎病、NB 和 NB 无明显定义，导致 NB 的发生率范围很广。
在 220 例接受颈椎脊髓病手术的患者中，排除了其他导致 LUTS 的颈椎和/或并存疾病，选择了 54 例患者。所有 LUTS 患者均转至泌尿科医生，并建议进行尿动力学检查（UDS）。根据最近的标准和 LUTS 与颈椎脊髓病病程之间的一致性，判断 NB 的存在。患者被分为 4 组：无症状、有症状但无 UDS 检查、有症状且 NB 阳性、有症状且 NB 阴性。比较手术前后各组的评估评分。
NB 患者无特殊 LUTS。在单纯性颈椎病患者中，LUTS 的发生率为 53.7%，NB 的发生率至少为 20.4%。所有 4 组患者术后评分均有所改善（P < 0.05）；然而，NB 组的恢复率（47.1%）是最差的（无症状组为 69.3%；NB 阴性组为 53.5%；有症状但无 UDS 组为 57.1%）。术前各部分评分在各组之间无差异，而 NB 组术后手指和下肢评分较低。事后分析证实，仅在 NB 组，NB 与较差的恢复率相关。
本研究首次根据最近的标准描述了单纯性颈椎病患者 LUTS 和 NB 的发生率，结果表明 NB 患者的神经功能可能恢复；然而，程度将限于无 NB 患者的三分之二；此外，剩余症状源于下肢功能不佳。
