Division of Neurosurgery, University of Toronto, Toronto Western Hospital, West Wing, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail address for M.G. Fehlings:
J Bone Joint Surg Am. 2013 Sep 18;95(18):1651-8. doi: 10.2106/JBJS.L.00589.
Cervical spondylotic myelopathy is the leading cause of spinal cord dysfunction worldwide. The objective of this study was to evaluate the impact of surgical decompression on functional, quality-of-life, and disability outcomes at one year after surgery in a large cohort of patients with this condition.
Adult patients with symptomatic cervical spondylotic myelopathy and magnetic resonance imaging evidence of spinal cord compression were enrolled at twelve North American centers from 2005 to 2007. At enrollment, the myelopathy was categorized as mild (modified Japanese Orthopaedic Association [mJOA] score ≥ 15), moderate (mJOA = 12 to 14), or severe (mJOA < 12). Patients were followed prospectively for one year, at which point the outcomes of interest included the mJOA score, Nurick grade, Neck Disability Index (NDI), and Short Form-36 version 2 (SF-36v2). All outcomes at one year were compared with the preoperative values with use of univariate paired statistics. Outcomes were also compared among the severity classes with use of one-way analysis of variance. Finally, a multivariate analysis that adjusted for baseline differences among the severity groups was performed. Treatment-related complication data were collected and the overall complication rate was calculated.
Eighty-five (30.6%) of the 278 enrolled patients had mild cervical spondylotic myelopathy, 110 (39.6%) had moderate disease, and 83 (29.9%) had severe disease preoperatively. One-year follow-up data were available for 222 (85.4%) of 260 patients. There was a significant improvement from baseline to one year postoperatively (p < 0.05) in the mJOA score, Nurick grade, NDI score, and all SF-36v2 health dimensions (including the mental and physical health composite scores) except general health. With the exception of the change in the mJOA, the degree of improvement did not depend on the severity of the preoperative symptoms. These results remained unchanged after adjusting for relevant confounders in the multivariate analysis. Fifty-two patients experienced complications (prevalence, 18.7%), with no significant differences among the severity groups.
Surgical decompression for the treatment of cervical spondylotic myelopathy was associated with improvement in functional, disability-related, and quality-of-life outcomes at one year of follow-up for all disease severity categories. Furthermore, complication rates observed in the study were commensurate with those in previously reported cervical spondylotic myelopathy series.
颈椎脊髓病是全球导致脊髓功能障碍的主要原因。本研究的目的是评估在 12 个北美中心的大样本颈椎脊髓病患者中，手术减压对术后 1 年时功能、生活质量和残疾结局的影响。
2005 年至 2007 年，12 个北美中心招募了有症状的颈椎脊髓病和脊髓压迫磁共振成像证据的成年患者。入组时，脊髓病分为轻度（改良日本矫形协会[mJOA]评分≥15）、中度（mJOA=12-14）或重度（mJOA<12）。前瞻性随访 1 年，此时的主要结局包括 mJOA 评分、Nurick 分级、颈部残疾指数（NDI）和健康调查简表 36 版本 2（SF-36v2）。所有 1 年的结局都与术前值进行了单变量配对统计比较。还使用单因素方差分析比较了严重程度类别之间的结局。最后，进行了调整严重程度组间基线差异的多变量分析。收集了与治疗相关的并发症数据，并计算了总并发症发生率。
278 名入组患者中，85 名（30.6%）为轻度颈椎脊髓病，110 名（39.6%）为中度疾病，83 名（29.9%）为术前重度疾病。260 名患者中有 222 名（85.4%）可获得 1 年随访数据。与术前相比，术后 1 年 mJOA 评分、Nurick 分级、NDI 评分和所有 SF-36v2 健康维度（包括心理健康和身体健康综合评分）均有显著改善（p<0.05），除了一般健康维度。除 mJOA 变化外，改善程度与术前症状严重程度无关。在多变量分析中调整了相关混杂因素后，这些结果仍然不变。52 名患者发生并发症（发生率 18.7%），各组间无显著差异。
对于所有疾病严重程度类别的患者，颈椎脊髓病的手术减压治疗与术后 1 年时功能、残疾相关和生活质量结局的改善相关。此外，本研究中观察到的并发症发生率与先前报道的颈椎脊髓病系列中一致。
